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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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 Major","code_information":[{"code":"003","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":167742.1,"maximum":291606.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":291606.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194404.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194404.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":204318.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":172107.22},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":167742.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194404.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194404.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":186380.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194404.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194404.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194404.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194404.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194404.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194404.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194404.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":214666.31},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":191843.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194404.25,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":110593.69,"maximum":191044.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":191044.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":127363.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":127363.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":133858.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":113471.65},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":110593.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":127363.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":127363.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":122881.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":127363.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":127363.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":127363.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":127363.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":127363.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":127363.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":127363.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":141531.19},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":126483.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":127363.19,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":108419.31,"10th_percentile":108419.31,"90th_percentile":108419.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":129480.54,"10th_percentile":129480.54,"90th_percentile":129480.54,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":110800.6,"10th_percentile":110800.6,"90th_percentile":110800.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":109315.44,"10th_percentile":109315.44,"90th_percentile":109315.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant With Mcc Or Intestinal Transplant","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":83350.53,"maximum":142755.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":142755.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95170.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95170.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":100023.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":85519.55},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":83350.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95170.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95170.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":92611.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95170.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95170.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95170.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95170.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95170.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95170.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95170.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106667.03},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":95326.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95170.06,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant Without Mcc","code_information":[{"code":"006","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37954.13,"maximum":65381.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65381.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43587.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43587.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45810.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":38941.81},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37954.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43587.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43587.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42171.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43587.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43587.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43587.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43587.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43587.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43587.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43587.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48571.43},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43407.35},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43587.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lung Transplant","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":102287.29,"maximum":178754.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":178754.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119169.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119169.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":125247.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":104949.09},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":102287.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119169.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119169.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":113652.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119169.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119169.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119169.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119169.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119169.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119169.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119169.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130901.15},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":116983.84},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":119169.66,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42587.15,"maximum":78577.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78577.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52384.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52384.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55056.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":43695.39},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42587.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52384.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52384.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47319.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52384.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52384.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52384.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52384.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52384.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52384.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52384.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54500.49},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48706.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52384.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5865.05,"maximum":13062.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13062.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8708.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8708.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9152.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6017.67},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5865.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8708.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8708.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6516.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8708.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8708.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8708.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8708.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8708.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8708.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8708.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7505.74},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6707.73},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8708.02,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":195.37,"10th_percentile":195.37,"90th_percentile":195.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer With Mcc","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9895.36,"maximum":20973.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20973.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13982.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13982.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14695.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10152.87},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9895.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13982.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13982.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10994.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13982.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13982.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13982.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13982.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13982.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13982.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13982.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12663.49},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11317.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13982.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 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":10807.23,"10th_percentile":10807.23,"90th_percentile":10807.23,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6806.68,"maximum":13801.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13801.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9200.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9200.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9670.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6983.81},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6806.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9200.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9200.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7562.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9200.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9200.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9200.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9200.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9200.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9200.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9200.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8710.78},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7784.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9200.79,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12717.13,"maximum":23722.60,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23722.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15815.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15815.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16621.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13048.06},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12717.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15815.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15815.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14130.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15815.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15815.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15815.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15815.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15815.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15815.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15815.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16274.62},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14544.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15815.07,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":19341.59,"10th_percentile":19341.59,"90th_percentile":19341.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":14965.5,"10th_percentile":14965.5,"90th_percentile":14965.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8078.85,"10th_percentile":8078.85,"90th_percentile":8078.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7767.88,"maximum":15458.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15458.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10305.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10305.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10831.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7970.02},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7767.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10305.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10305.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8630.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10305.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10305.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10305.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10305.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10305.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10305.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10305.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9940.87},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8883.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10305.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":6212.77,"10th_percentile":6212.77,"90th_percentile":6212.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10389.76,"10th_percentile":10389.76,"90th_percentile":10389.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":19101.32,"10th_percentile":19101.32,"90th_percentile":19101.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5246.69,"maximum":11435.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11435.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7623.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7623.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8012.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5383.22},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5246.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7623.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7623.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5829.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7623.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7623.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7623.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7623.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7623.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7623.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7623.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6714.4},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6000.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7623.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":14459.62,"10th_percentile":14459.62,"90th_percentile":14459.62,"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":5808.59,"10th_percentile":5808.59,"90th_percentile":5808.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6179.85,"10th_percentile":6179.85,"90th_percentile":6179.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":141.92,"10th_percentile":141.92,"90th_percentile":141.92,"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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4389.97,"10th_percentile":4389.97,"90th_percentile":4389.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11506.23,"maximum":22283.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22283.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14855.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14855.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15613.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11805.66},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11506.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14855.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14855.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12784.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14855.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14855.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14855.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14855.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14855.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14855.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14855.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14724.99},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13159.44},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14855.89,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":28589.14,"10th_percentile":28589.14,"90th_percentile":28589.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8865.68,"10th_percentile":8865.68,"90th_percentile":8865.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":13606.8,"10th_percentile":13606.8,"90th_percentile":13606.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11375.81,"10th_percentile":11375.81,"90th_percentile":11375.81,"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":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12279.27,"10th_percentile":12279.27,"90th_percentile":12279.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":24097.74,"10th_percentile":24097.74,"90th_percentile":24097.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5209.49,"10th_percentile":5209.49,"90th_percentile":5209.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12134.6,"10th_percentile":12134.6,"90th_percentile":12134.6,"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":"1 through 10","median_amount":10792.09,"10th_percentile":10792.09,"90th_percentile":10792.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":21982.16,"10th_percentile":21982.16,"90th_percentile":21982.16,"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":"1 through 10","median_amount":13134.01,"10th_percentile":13134.01,"90th_percentile":13134.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6275.2,"maximum":12914.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12914.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8609.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8609.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9048.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6438.5},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6275.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8609.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8609.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6972.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8609.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8609.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8609.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8609.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8609.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8609.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8609.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8030.63},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7176.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8609.83,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":7232.81,"10th_percentile":7232.81,"90th_percentile":7232.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7273.25,"10th_percentile":7273.25,"90th_percentile":7273.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":29948.08,"10th_percentile":29948.08,"90th_percentile":29948.08,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7239.83,"10th_percentile":7239.83,"90th_percentile":7239.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8074.44,"10th_percentile":8074.44,"90th_percentile":8074.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":24404.29,"10th_percentile":24404.29,"90th_percentile":24404.29,"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":"1 through 10","median_amount":7248.83,"10th_percentile":7248.83,"90th_percentile":7248.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7929.08,"10th_percentile":7929.08,"90th_percentile":7929.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6175.95,"10th_percentile":5504.7,"90th_percentile":6479.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6786.73,"10th_percentile":5856.81,"90th_percentile":7207.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9917.15,"10th_percentile":9917.15,"90th_percentile":9917.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5584.71,"10th_percentile":5584.71,"90th_percentile":5584.71,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6299.47,"10th_percentile":6299.47,"90th_percentile":6299.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":8029.63,"10th_percentile":8029.63,"90th_percentile":8029.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5417.03,"10th_percentile":5417.03,"90th_percentile":6674.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4282.35,"maximum":9562.60,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9562.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6375.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6375.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6700.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":4393.79},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4282.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6375.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6375.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":4758.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6375.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6375.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6375.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6375.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6375.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6375.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6375.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5480.3},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4897.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6375.07,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":7045.4,"10th_percentile":7045.4,"90th_percentile":7045.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3794.15,"10th_percentile":3794.15,"90th_percentile":3794.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5714.38,"10th_percentile":5714.38,"90th_percentile":5714.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4094.15,"10th_percentile":4094.15,"90th_percentile":4094.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":20544.43,"10th_percentile":19461.47,"90th_percentile":24680.31,"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":"1 through 10","median_amount":7280.3,"10th_percentile":7280.3,"90th_percentile":7280.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4004.26,"10th_percentile":4004.26,"90th_percentile":4004.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5202.13,"10th_percentile":5202.13,"90th_percentile":5202.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5452.54,"10th_percentile":5452.54,"90th_percentile":5452.54,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":5481.3,"10th_percentile":5481.3,"90th_percentile":5481.3,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4715.06,"10th_percentile":4715.06,"90th_percentile":5287.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10057.39,"maximum":19440.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19440.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12960.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12960.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13621.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10319.11},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10057.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12960.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12960.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11174.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12960.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12960.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12960.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12960.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12960.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12960.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12960.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12870.84},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11502.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12960.25,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20055.05,"10th_percentile":20055.05,"90th_percentile":20055.05,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7407.85,"10th_percentile":6561.28,"90th_percentile":16072.83,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":3722.17,"10th_percentile":3722.17,"90th_percentile":3722.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":31316.92,"10th_percentile":31316.92,"90th_percentile":31316.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8261.1,"10th_percentile":8261.1,"90th_percentile":8261.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10898.89,"10th_percentile":10544.88,"90th_percentile":11182.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":10811.06,"10th_percentile":10811.06,"90th_percentile":10811.06,"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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":538.13,"10th_percentile":538.13,"90th_percentile":538.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6107.7,"maximum":12775.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12775.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8517.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8517.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8951.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6266.64},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6107.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8517.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8517.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6786.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8517.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8517.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8517.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8517.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8517.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8517.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8517.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7816.27},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6985.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8517.09,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":10082.68,"10th_percentile":10082.68,"90th_percentile":10082.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4863.45,"10th_percentile":4863.45,"90th_percentile":8192.52,"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":"1 through 10","median_amount":6988.92,"10th_percentile":6988.92,"90th_percentile":6988.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":38224.4,"10th_percentile":38224.4,"90th_percentile":38224.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18642.62,"10th_percentile":18642.62,"90th_percentile":19152.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6384.52,"10th_percentile":4541.65,"90th_percentile":7997.62,"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":"1 through 10","median_amount":7210.2,"10th_percentile":7210.2,"90th_percentile":7210.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":19421.67,"10th_percentile":18491.42,"90th_percentile":24262.96,"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":6823.61,"10th_percentile":6739.26,"90th_percentile":14132.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7066.0,"10th_percentile":7066.0,"90th_percentile":7066.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":5817.15,"10th_percentile":4188.9,"90th_percentile":9410.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6563.34,"10th_percentile":6563.34,"90th_percentile":6827.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1149.08,"10th_percentile":1149.08,"90th_percentile":1149.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":7809.25,"10th_percentile":7809.25,"90th_percentile":9858.02,"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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6586.09,"10th_percentile":5701.2,"90th_percentile":7074.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12961.34,"maximum":23954.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23954.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15969.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15969.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16784.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13298.63},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12961.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15969.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15969.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14401.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15969.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15969.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15969.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15969.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15969.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15969.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15969.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16587.15},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14823.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15969.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8822.83,"10th_percentile":8822.83,"90th_percentile":8822.83,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":13779.32,"10th_percentile":13779.32,"90th_percentile":13779.32,"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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 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":9881.35,"10th_percentile":9881.35,"90th_percentile":9881.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16639.67,"10th_percentile":16639.67,"90th_percentile":16639.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13736.85,"10th_percentile":13736.85,"90th_percentile":13736.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12233.82,"10th_percentile":12233.82,"90th_percentile":12233.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13102.11,"10th_percentile":13102.11,"90th_percentile":13102.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7367.9,"maximum":14904.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14904.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9936.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9936.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10443.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7559.64},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7367.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9936.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9936.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8186.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9936.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9936.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9936.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9936.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9936.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9936.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9936.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9429.0},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8426.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9936.32,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5548.35,"10th_percentile":5548.35,"90th_percentile":7442.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7074.39,"10th_percentile":7074.39,"90th_percentile":7074.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44563.54,"10th_percentile":44563.54,"90th_percentile":44563.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8185.71,"10th_percentile":8185.71,"90th_percentile":8218.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":18162.7,"10th_percentile":18162.7,"90th_percentile":18162.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6533.84,"10th_percentile":6533.84,"90th_percentile":6533.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7657.66,"10th_percentile":7657.66,"90th_percentile":8551.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6803.7,"10th_percentile":6803.7,"90th_percentile":6803.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4981.34,"maximum":10994.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10994.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7703.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5110.97},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4981.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5534.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6374.82},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5697.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7329.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18126.18,"10th_percentile":18126.18,"90th_percentile":18126.18,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4323.88,"10th_percentile":4323.88,"90th_percentile":4323.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":227.08,"10th_percentile":227.08,"90th_percentile":227.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":1123.0,"10th_percentile":1123.0,"90th_percentile":1123.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19393.09,"maximum":34804.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34804.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23203.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23203.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24386.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19897.75},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19393.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23203.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23203.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21547.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23203.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23203.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23203.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23203.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23203.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23203.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23203.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24818.12},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22179.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23203.06,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11845.16,"maximum":22785.70,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22785.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15190.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15190.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15965.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12153.4},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11845.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15190.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15190.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13161.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15190.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15190.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15190.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15190.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15190.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15190.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15190.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15158.73},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13547.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15190.47,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":12799.88,"10th_percentile":12799.88,"90th_percentile":12799.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":14565.4,"10th_percentile":14565.4,"90th_percentile":14565.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8617.84,"10th_percentile":8617.84,"90th_percentile":8617.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":9005.68,"10th_percentile":9005.68,"90th_percentile":9005.68,"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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8798.75,"maximum":17754.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17754.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11836.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11836.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12440.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9027.71},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8798.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11836.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11836.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9776.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11836.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11836.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11836.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11836.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11836.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11836.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11836.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11260.11},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10062.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11836.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10300.98,"10th_percentile":10300.98,"90th_percentile":10300.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":46513.73,"10th_percentile":46513.73,"90th_percentile":46513.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":50268.32,"10th_percentile":50268.32,"90th_percentile":52277.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7038.14,"10th_percentile":7038.14,"90th_percentile":7038.14,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","code_information":[{"code":"402","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30755.3,"maximum":56974.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56974.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37982.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37982.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39919.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31555.64},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30755.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37982.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37982.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34172.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37982.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37982.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37982.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37982.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37982.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37982.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37982.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39358.8},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35174.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37982.68,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":25868.11,"10th_percentile":25868.11,"90th_percentile":25868.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":181284.08,"10th_percentile":181284.08,"90th_percentile":245524.96,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":20496.93,"10th_percentile":20496.93,"90th_percentile":20496.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":131619.39,"10th_percentile":131619.39,"90th_percentile":153282.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31078.83,"10th_percentile":31078.83,"90th_percentile":31078.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":28551.87,"10th_percentile":28551.87,"90th_percentile":28551.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":20322.42,"10th_percentile":20322.42,"90th_percentile":20322.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Mcc","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42490.1,"maximum":76748.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76748.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51165.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51165.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53775.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":43595.81},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42490.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51165.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51165.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47211.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51165.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51165.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51165.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51165.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51165.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51165.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51165.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54376.28},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48595.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51165.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Cc","code_information":[{"code":"406","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21980.82,"maximum":41695.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41695.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27797.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27797.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29214.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22552.82},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21980.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27797.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27797.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24423.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27797.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27797.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27797.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27797.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27797.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27797.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27797.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28129.74},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25139.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27797.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16716.13,"maximum":32413.90,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32413.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21609.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21609.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22711.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17151.13},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16716.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21609.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21609.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18573.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21609.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21609.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21609.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21609.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21609.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21609.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21609.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21392.31},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19117.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21609.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27404.41,"maximum":50770.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50770.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33846.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33846.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35573.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28117.54},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27404.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33846.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33846.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30449.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33846.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33846.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33846.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33846.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33846.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33846.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33846.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35070.52},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31341.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33846.83,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16408.52,"maximum":31837.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31837.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21224.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21224.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22307.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16835.51},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16408.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21224.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21224.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18231.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21224.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21224.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21224.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21224.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21224.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21224.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21224.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20998.64},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18766.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21224.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","code_information":[{"code":"410","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12140.25,"maximum":23796.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23796.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15864.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15864.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16673.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12456.17},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12140.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15864.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15864.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13489.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15864.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15864.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15864.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15864.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15864.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15864.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15864.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15536.37},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13884.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15864.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Mcc","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21418.82,"maximum":47193.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47193.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31462.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31462.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33066.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21976.19},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21418.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31462.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31462.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23798.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31462.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31462.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31462.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31462.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31462.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31462.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31462.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27410.52},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24496.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31462.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22301.65,"10th_percentile":22301.65,"90th_percentile":22301.65,"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] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":18255.59,"10th_percentile":18255.59,"90th_percentile":18255.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8524.79,"maximum":16920.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16920.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11280.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11280.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11855.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8746.63},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8524.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11280.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11280.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9471.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11280.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11280.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11280.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11280.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11280.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11280.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11280.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10909.51},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9749.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11280.09,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9778.24,"10th_percentile":9778.24,"90th_percentile":9778.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9472.86,"10th_percentile":9472.86,"90th_percentile":9711.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15062.21,"maximum":28903.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28903.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19269.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19269.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20251.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15454.17},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15062.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19269.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19269.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16735.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19269.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19269.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19269.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19269.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19269.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19269.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19269.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19275.71},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17226.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19269.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":24397.41,"10th_percentile":24397.41,"90th_percentile":24397.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7378.0,"10th_percentile":7378.0,"90th_percentile":7378.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in 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":15797.44,"10th_percentile":15797.44,"90th_percentile":15797.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15850.05,"10th_percentile":15850.05,"90th_percentile":15850.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14180.27,"10th_percentile":14180.27,"90th_percentile":14180.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4982.9,"maximum":10740.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10740.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7160.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7160.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7525.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5112.57},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4982.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7160.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7160.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5536.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7160.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7160.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7160.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7160.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7160.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7160.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7160.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6376.82},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5698.84},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7160.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":5898.18,"10th_percentile":5898.18,"90th_percentile":5898.18,"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":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7092.92,"10th_percentile":7092.92,"90th_percentile":7092.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":538.13,"10th_percentile":538.13,"90th_percentile":538.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7717.0,"maximum":15518.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15518.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10345.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10345.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10873.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7917.82},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7717.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10345.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10345.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8574.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10345.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10345.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10345.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10345.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10345.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10345.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10345.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9875.76},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8825.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10345.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":12306.93,"10th_percentile":12306.93,"90th_percentile":12306.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6888.16,"10th_percentile":6888.16,"90th_percentile":6888.16,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8684.7,"10th_percentile":8684.7,"90th_percentile":8701.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":37699.75,"10th_percentile":37699.75,"90th_percentile":37699.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6545.82,"10th_percentile":6545.82,"90th_percentile":9392.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7948.32,"10th_percentile":7948.32,"90th_percentile":7948.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8567.5,"10th_percentile":8567.5,"90th_percentile":8567.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":33967.29,"10th_percentile":33967.29,"90th_percentile":33967.29,"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":"1 through 10","median_amount":7924.79,"10th_percentile":7924.79,"90th_percentile":7924.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8429.53,"10th_percentile":6176.64,"90th_percentile":11684.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8596.13,"10th_percentile":1821.51,"90th_percentile":8655.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8837.52,"10th_percentile":8837.52,"90th_percentile":8837.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5379.04,"10th_percentile":5379.04,"90th_percentile":6312.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8265.98,"10th_percentile":7071.99,"90th_percentile":8704.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8444.34,"10th_percentile":8444.34,"90th_percentile":8444.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8181.36,"10th_percentile":8181.36,"90th_percentile":8181.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14230.94,"maximum":27073.40,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27073.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18048.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18048.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18969.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14601.27},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14230.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18048.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18048.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15812.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18048.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18048.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18048.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18048.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18048.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18048.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18048.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18211.91},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16275.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18048.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":19014.74,"10th_percentile":19014.74,"90th_percentile":19014.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8877.31,"10th_percentile":8877.31,"90th_percentile":8877.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15128.53,"10th_percentile":15128.53,"90th_percentile":15128.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13493.62,"10th_percentile":13493.62,"90th_percentile":13493.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10993.16,"10th_percentile":10993.16,"90th_percentile":14008.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15425.16,"10th_percentile":14770.1,"90th_percentile":15445.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15720.81,"10th_percentile":15720.81,"90th_percentile":15720.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11985.24,"10th_percentile":11985.24,"90th_percentile":11985.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7836.48,"10th_percentile":6340.18,"90th_percentile":15760.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13749.16,"10th_percentile":13749.16,"90th_percentile":13749.16,"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":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":17212.29,"10th_percentile":17212.29,"90th_percentile":17212.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":15046.27,"10th_percentile":15046.27,"90th_percentile":15046.27,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":16276.53,"10th_percentile":16276.53,"90th_percentile":16276.53,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15138.2,"10th_percentile":15138.2,"90th_percentile":15138.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy Without Cc/Mcc","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6910.78,"maximum":14749.00,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14749.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9832.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9832.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10334.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7090.62},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6910.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9832.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9832.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7678.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9832.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9832.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9832.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9832.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9832.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9832.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9832.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8844.01},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7903.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9832.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9617.49,"maximum":18639.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18639.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13060.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9867.76},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9617.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10686.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12307.89},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10999.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12426.56,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":226.17,"10th_percentile":226.17,"90th_percentile":226.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":12436.49,"10th_percentile":12436.49,"90th_percentile":12436.49,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6890.21,"10th_percentile":6890.21,"90th_percentile":6890.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10559.7,"10th_percentile":10559.7,"90th_percentile":10559.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Mcc","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16527.49,"maximum":31310.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31310.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20873.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20873.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21938.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16957.58},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16527.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20873.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20873.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18363.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20873.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20873.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20873.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20873.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20873.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20873.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20873.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21150.9},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18902.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20873.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":26602.55,"10th_percentile":26602.55,"90th_percentile":26602.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7963.21,"10th_percentile":7963.21,"90th_percentile":7963.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15968.41,"10th_percentile":15968.41,"90th_percentile":15968.41,"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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":217594.04,"10th_percentile":217594.04,"90th_percentile":217594.04,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15959.96,"10th_percentile":9698.99,"90th_percentile":18182.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15478.1,"10th_percentile":15478.1,"90th_percentile":15478.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5677.19,"maximum":12063.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12063.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8042.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8042.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8452.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5824.93},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5677.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8042.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8042.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6307.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8042.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8042.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8042.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8042.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8042.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8042.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8042.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7265.33},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6492.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8042.5,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":38308.03,"10th_percentile":38308.03,"90th_percentile":38308.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6391.63,"10th_percentile":6391.63,"90th_percentile":6391.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8056.71,"maximum":16067.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16067.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10711.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10711.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11258.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8266.37},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8056.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10711.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10711.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8951.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10711.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10711.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10711.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10711.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10711.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10711.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10711.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10310.5},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9214.29},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10711.85,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":5749.62,"10th_percentile":5749.62,"90th_percentile":5749.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6469.85,"10th_percentile":6469.85,"90th_percentile":6469.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8052.96,"10th_percentile":8052.96,"90th_percentile":8052.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11904.06,"10th_percentile":11904.06,"90th_percentile":11904.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":21761.09,"10th_percentile":21761.09,"90th_percentile":21761.09,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8987.33,"10th_percentile":8987.33,"90th_percentile":8987.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9030.92,"10th_percentile":9030.92,"90th_percentile":9030.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13684.59,"maximum":26324.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26324.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17549.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17549.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18444.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14040.7},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13684.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17549.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17549.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15205.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17549.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17549.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17549.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17549.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17549.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17549.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17549.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17512.72},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15650.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17549.79,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10087.43,"10th_percentile":10087.43,"90th_percentile":10087.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9008.37,"10th_percentile":9008.37,"90th_percentile":9008.37,"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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":29495.92,"10th_percentile":29495.92,"90th_percentile":29495.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7586.17,"10th_percentile":7586.17,"90th_percentile":7586.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":18711.63,"10th_percentile":18711.63,"90th_percentile":18711.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12636.64,"10th_percentile":12636.64,"90th_percentile":12636.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders Without Cc/Mcc","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5462.72,"maximum":11700.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11700.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7800.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7800.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8198.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5604.88},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5462.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7800.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7800.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6069.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7800.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7800.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7800.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7800.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7800.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7800.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7800.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6990.86},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6247.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7800.66,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6413.65,"10th_percentile":6413.65,"90th_percentile":6413.65,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7965.13,"maximum":15784.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15784.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10522.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10522.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11059.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8172.41},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7965.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10522.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10522.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8850.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10522.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10522.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10522.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10522.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10522.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10522.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10522.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10193.3},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9109.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10522.74,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":37564.81,"10th_percentile":37564.81,"90th_percentile":37564.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5086.49,"10th_percentile":5086.49,"90th_percentile":5086.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13070.93,"maximum":23853.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23853.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15902.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15902.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16713.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13411.07},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13070.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15902.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15902.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14523.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15902.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15902.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15902.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15902.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15902.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15902.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15902.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16727.39},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14948.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15902.35,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":13824.59,"10th_percentile":13824.59,"90th_percentile":13824.59,"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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":45716.92,"10th_percentile":45716.92,"90th_percentile":45716.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12936.34,"10th_percentile":12936.34,"90th_percentile":12936.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":16728.39,"10th_percentile":16728.39,"90th_percentile":16728.39,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10606.09,"maximum":21207.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21207.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14138.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14138.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14859.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10882.09},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10606.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14138.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14138.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11784.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14138.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14138.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14138.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14138.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14138.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14138.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14138.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13573.04},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12129.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14138.55,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":77811.4,"10th_percentile":77811.4,"90th_percentile":77811.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Cc","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17626.45,"maximum":33858.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33858.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22572.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22572.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23723.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18085.14},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17626.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22572.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22572.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19584.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22572.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22572.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22572.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22572.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22572.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22572.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22572.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22557.28},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20159.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22572.09,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Mcc","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33386.86,"maximum":62051.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62051.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41367.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41367.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43477.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":34255.68},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33386.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41367.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41367.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37096.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41367.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41367.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41367.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41367.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41367.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41367.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41367.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42726.51},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38183.86},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41367.56,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":33337.37,"10th_percentile":33337.37,"90th_percentile":33337.37,"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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32324.14,"10th_percentile":32324.14,"90th_percentile":32324.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10434.67,"maximum":20486.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20486.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13657.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13657.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14354.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10706.21},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10434.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13657.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13657.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11594.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13657.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13657.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13657.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13657.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13657.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13657.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13657.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13353.66},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11933.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13657.59,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9046.21,"10th_percentile":9046.21,"90th_percentile":9046.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2256.31,"10th_percentile":2256.31,"90th_percentile":2256.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":12733.57,"10th_percentile":12733.57,"90th_percentile":12733.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13315.14,"maximum":25087.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25087.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16725.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16725.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17578.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13661.64},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13315.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16725.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16725.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14794.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16725.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16725.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16725.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16725.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16725.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16725.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16725.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17039.92},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15228.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16725.16,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":106817.25,"10th_percentile":106817.25,"90th_percentile":106817.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 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":22907.26,"10th_percentile":22907.26,"90th_percentile":22907.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14605.98,"10th_percentile":14605.98,"90th_percentile":14605.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8473.22,"10th_percentile":8473.22,"90th_percentile":8473.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11292.91,"10th_percentile":11292.91,"90th_percentile":12651.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Mcc","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22956.11,"maximum":41720.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41720.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27813.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27813.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29232.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23553.49},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22956.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27813.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27813.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25506.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27813.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27813.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27813.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27813.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27813.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27813.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27813.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29377.86},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26254.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27813.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8629.68,"maximum":18069.80,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18069.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12046.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12046.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12660.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8854.24},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8629.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12046.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12046.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9588.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12046.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12046.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12046.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12046.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12046.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12046.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12046.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11043.74},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9869.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12046.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":9585.53,"10th_percentile":9585.53,"90th_percentile":9585.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9603.19,"10th_percentile":9603.19,"90th_percentile":9603.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11777.84,"maximum":22934.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22934.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15289.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15289.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16069.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12084.34},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11777.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15289.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15289.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13086.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15289.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15289.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15289.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15289.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15289.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15289.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15289.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15072.58},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13470.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15289.57,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"1 through 10","median_amount":6774.02,"10th_percentile":6774.02,"90th_percentile":6774.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11311.78,"10th_percentile":11311.78,"90th_percentile":11311.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9592.82,"10th_percentile":9592.82,"90th_percentile":9592.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Mcc","code_information":[{"code":"350","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18940.67,"maximum":36127.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36127.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24084.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24084.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25313.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19433.56},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18940.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24084.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24084.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21045.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24084.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24084.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24084.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24084.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24084.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24084.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24084.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24239.14},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21662.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24084.97,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19661.62,"10th_percentile":19661.62,"90th_percentile":19661.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures Without Cc/Mcc","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6895.13,"maximum":14016.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14016.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9344.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9344.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9821.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7074.56},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6895.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9344.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9344.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7661.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9344.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9344.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9344.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9344.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9344.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9344.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9344.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8823.98},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7885.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9344.44,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Cc","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9853.09,"maximum":19992.70,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19992.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13328.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13328.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14008.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10109.5},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9853.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13328.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13328.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10947.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13328.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13328.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13328.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13328.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13328.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13328.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13328.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12609.4},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11268.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13328.47,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8230.05,"10th_percentile":8230.05,"90th_percentile":8230.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Mcc","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18524.25,"maximum":33450.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33450.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22300.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22300.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23437.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19006.31},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18524.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22300.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22300.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20582.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22300.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22300.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22300.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22300.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22300.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22300.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22300.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23706.23},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21185.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22300.25,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9746.64,"maximum":18320.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18320.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12213.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12213.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12836.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10000.28},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9746.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12213.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12213.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10829.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12213.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12213.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12213.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12213.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12213.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12213.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12213.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12473.17},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11147.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12213.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":16356.5,"10th_percentile":16356.5,"90th_percentile":16356.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":96924.0,"10th_percentile":96924.0,"90th_percentile":96924.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Cc","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11656.52,"maximum":22664.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22664.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15109.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15109.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15880.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11959.85},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11656.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15109.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15109.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12951.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15109.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15109.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15109.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15109.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15109.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15109.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15109.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14917.32},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13331.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15109.55,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7651.25,"10th_percentile":7651.25,"90th_percentile":7651.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21090.07,"maximum":37367.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37367.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24911.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24911.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26181.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21638.89},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21090.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24911.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24911.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23433.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24911.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24911.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24911.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24911.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24911.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24911.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24911.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26989.8},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24120.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24911.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":21667.2,"10th_percentile":21667.2,"90th_percentile":21667.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21972.78,"10th_percentile":21972.78,"90th_percentile":21972.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12015.01,"maximum":23077.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23077.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15385.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15385.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16169.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12327.68},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12015.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15385.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15385.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13350.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15385.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15385.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15385.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15385.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15385.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15385.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15385.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15376.1},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13741.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15385.03,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":57412.53,"10th_percentile":57412.53,"90th_percentile":57412.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16534.54,"maximum":30901.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30901.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20600.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20600.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21651.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16964.81},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16534.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20600.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20600.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18371.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20600.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20600.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20600.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20600.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20600.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20600.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20600.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21159.91},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18910.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20600.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":93999.55,"10th_percentile":93999.55,"90th_percentile":93999.55,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":16305.02,"10th_percentile":16305.02,"90th_percentile":16305.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11872.24,"10th_percentile":11872.24,"90th_percentile":11872.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28365.61,"maximum":50842.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50842.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33895.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33895.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35623.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":29103.76},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28365.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33895.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33895.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31517.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33895.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33895.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33895.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33895.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33895.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33895.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33895.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36300.61},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32441.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33895.01,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection Without Cc/Mcc","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12980.91,"maximum":24480.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24480.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16320.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16320.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17152.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13318.71},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12980.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16320.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16320.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14423.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16320.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16320.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16320.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16320.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16320.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16320.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16320.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16612.19},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14846.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16320.58,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Cc","code_information":[{"code":"333","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16633.94,"maximum":34085.90,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34085.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22723.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22723.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23882.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17066.81},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16633.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22723.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22723.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18482.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22723.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22723.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22723.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22723.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22723.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22723.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22723.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21287.13},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19023.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22723.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Mcc","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27149.23,"maximum":51521.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51521.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34347.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34347.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36099.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27855.73},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27149.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34347.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34347.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30165.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34347.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34347.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34347.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34347.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34347.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34347.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34347.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34743.96},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31050.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34347.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12922.99,"maximum":25094.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25094.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16729.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16729.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17582.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13259.28},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12922.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16729.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16729.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14358.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16729.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16729.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16729.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16729.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16729.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16729.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16729.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16538.07},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14779.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16729.71,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9428.12,"10th_percentile":9428.12,"90th_percentile":9428.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13753.47,"10th_percentile":13753.47,"90th_percentile":13753.47,"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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":99228.79,"10th_percentile":99228.79,"90th_percentile":99228.79,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":89248.82,"10th_percentile":89248.82,"90th_percentile":89248.82,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":13670.51,"10th_percentile":13670.51,"90th_percentile":13670.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":64717.28,"10th_percentile":64717.28,"90th_percentile":74870.29,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14609.78,"10th_percentile":14609.78,"90th_percentile":14609.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18501.55,"maximum":34835.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34835.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23223.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23223.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24408.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18983.02},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18501.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23223.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23223.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20557.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23223.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23223.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23223.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23223.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23223.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23223.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23223.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23677.18},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21159.84},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23223.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":18826.97,"10th_percentile":18826.97,"90th_percentile":18826.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":15916.79,"10th_percentile":15916.79,"90th_percentile":15916.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19397.32,"10th_percentile":19397.32,"90th_percentile":19397.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":91439.2,"10th_percentile":91439.2,"90th_percentile":91439.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":94537.69,"10th_percentile":94537.69,"90th_percentile":94537.69,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12963.17,"10th_percentile":12963.17,"90th_percentile":15787.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19150.5,"10th_percentile":19150.5,"90th_percentile":19150.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":53005.31,"10th_percentile":53005.31,"90th_percentile":53005.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":17241.13,"10th_percentile":17241.13,"90th_percentile":17241.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17866.64,"10th_percentile":17866.64,"90th_percentile":17866.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":22317.38,"10th_percentile":22317.38,"90th_percentile":22317.38,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19338.23,"10th_percentile":19338.23,"90th_percentile":19338.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35940.93,"maximum":64829.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64829.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43219.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43219.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45423.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":36876.22},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35940.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43219.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43219.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39934.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43219.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43219.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43219.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43219.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43219.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43219.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43219.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45995.06},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41104.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43219.56,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":13679.66,"10th_percentile":13679.66,"90th_percentile":13679.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":34279.67,"10th_percentile":34279.67,"90th_percentile":34279.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":113666.2,"10th_percentile":113666.2,"90th_percentile":113666.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":34466.45,"10th_percentile":34466.45,"90th_percentile":34466.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31320.25,"10th_percentile":31320.25,"90th_percentile":31320.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36306.38,"10th_percentile":36306.38,"90th_percentile":36306.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":129280.26,"10th_percentile":94431.99,"90th_percentile":133863.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44848.33,"10th_percentile":44848.33,"90th_percentile":44848.33,"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":"1 through 10","median_amount":23568.09,"10th_percentile":23568.09,"90th_percentile":32343.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36297.98,"10th_percentile":36297.98,"90th_percentile":36297.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":10592.38,"10th_percentile":10592.38,"90th_percentile":10592.38,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24681.92,"10th_percentile":24681.92,"90th_percentile":34695.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12472.13,"maximum":23995.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23995.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15996.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15996.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16812.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12796.69},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12472.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15996.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15996.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13857.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15996.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15996.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15996.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15996.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15996.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15996.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15996.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15961.09},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14264.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15996.91,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 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":13404.64,"10th_percentile":13404.64,"90th_percentile":13404.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":69630.54,"10th_percentile":69630.54,"90th_percentile":69630.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18991.53,"10th_percentile":18991.53,"90th_percentile":18991.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":147649.2,"10th_percentile":147649.2,"90th_percentile":147649.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18321.08,"10th_percentile":18321.08,"90th_percentile":18321.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40409.63,"10th_percentile":40409.63,"90th_percentile":40409.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22401.93,"maximum":45926.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45926.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30617.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30617.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32178.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22984.89},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22401.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30617.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30617.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24891.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30617.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30617.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30617.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30617.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30617.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30617.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30617.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28668.65},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25620.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30617.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":22215.58,"10th_percentile":22215.58,"90th_percentile":22215.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23043.89,"10th_percentile":23043.89,"90th_percentile":23043.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25008.45,"maximum":45116.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45116.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30077.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30077.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31611.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25659.24},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25008.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30077.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30077.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27787.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30077.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30077.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30077.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30077.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30077.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30077.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30077.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32004.32},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28601.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30077.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":120851.17,"10th_percentile":120851.17,"90th_percentile":120851.17,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5381.66,"10th_percentile":5381.66,"90th_percentile":5381.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":16196.88,"10th_percentile":16196.88,"90th_percentile":16196.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":29153.02,"10th_percentile":29153.02,"90th_percentile":29153.02,"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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25841.14,"10th_percentile":25841.14,"90th_percentile":25841.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33338.33,"maximum":61159.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61159.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40772.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40772.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42852.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":34205.89},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33338.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40772.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40772.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37042.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40772.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40772.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40772.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40772.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40772.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40772.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40772.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42664.41},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38128.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40772.95,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":34080.26,"10th_percentile":34080.26,"90th_percentile":34080.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 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":5128.54,"10th_percentile":5128.54,"90th_percentile":5128.54,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32838.03,"10th_percentile":32838.03,"90th_percentile":32838.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32384.68,"10th_percentile":32384.68,"90th_percentile":32384.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":19538.32,"10th_percentile":19538.32,"90th_percentile":19538.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32334.01,"10th_percentile":32334.01,"90th_percentile":34078.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14160.5,"maximum":26186.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26186.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17457.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17457.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18348.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14528.99},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14160.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17457.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17457.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15733.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17457.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17457.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17457.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17457.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17457.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17457.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17457.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18121.75},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16195.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17457.96,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":20338.32,"10th_percentile":18407.54,"90th_percentile":23060.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":17980.75,"10th_percentile":17407.76,"90th_percentile":19922.16,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15046.84,"10th_percentile":15037.76,"90th_percentile":15087.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":75102.54,"10th_percentile":74367.58,"90th_percentile":94396.8,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":142195.32,"10th_percentile":142195.32,"90th_percentile":142195.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":15080.78,"10th_percentile":15059.01,"90th_percentile":15632.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in 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":15353.92,"10th_percentile":15353.92,"90th_percentile":15353.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15211.08,"10th_percentile":15211.08,"90th_percentile":15211.08,"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":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":112320.43,"10th_percentile":80042.44,"90th_percentile":141039.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":16196.88,"10th_percentile":14260.81,"90th_percentile":17245.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13469.5,"10th_percentile":13469.5,"90th_percentile":13469.5,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":14937.6,"10th_percentile":14528.81,"90th_percentile":15234.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":16769.87,"10th_percentile":16769.87,"90th_percentile":23782.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":14775.74,"10th_percentile":14775.74,"90th_percentile":20678.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":16195.96,"10th_percentile":16195.96,"90th_percentile":16195.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15071.28,"10th_percentile":15039.76,"90th_percentile":15084.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"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":22282.17,"maximum":39249.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39249.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26166.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26166.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27500.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22862.02},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22282.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26166.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26166.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24757.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26166.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26166.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26166.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26166.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26166.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26166.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26166.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28515.39},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25483.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26166.08,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":165359.55,"10th_percentile":165359.55,"90th_percentile":165359.55,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":29045.22,"10th_percentile":29045.22,"90th_percentile":29045.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23597.69,"10th_percentile":23597.69,"90th_percentile":23597.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22859.51,"10th_percentile":22859.51,"90th_percentile":22859.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":128538.77,"10th_percentile":128538.77,"90th_percentile":128538.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21592.87,"10th_percentile":14745.84,"90th_percentile":22886.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the 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":22955.76,"10th_percentile":22955.76,"90th_percentile":22955.76,"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":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":20809.69,"10th_percentile":20809.69,"90th_percentile":20809.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":21662.96,"10th_percentile":21662.96,"90th_percentile":21662.96,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21272.37,"10th_percentile":21272.37,"90th_percentile":21272.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18117.23,"maximum":34946.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34946.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23297.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23297.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24485.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18588.69},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18117.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23297.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23297.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20130.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23297.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23297.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23297.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23297.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23297.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23297.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23297.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23185.35},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20720.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23297.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures With Mcc","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34381.72,"maximum":63007.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63007.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42004.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42004.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44147.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":35276.43},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34381.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42004.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42004.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38201.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42004.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42004.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42004.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42004.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42004.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42004.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42004.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43999.67},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39321.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42004.89,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48420.11,"maximum":93332.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93332.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62221.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62221.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65394.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":49680.14},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48420.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62221.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62221.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53800.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62221.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62221.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62221.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62221.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62221.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62221.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62221.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61965.16},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55377.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62221.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5342.96,"maximum":11445.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11445.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7630.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7630.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8019.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5482.0},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5342.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7630.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7630.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5936.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7630.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7630.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7630.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7630.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7630.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7630.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7630.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6837.6},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6110.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7630.64,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":8752.2,"10th_percentile":8752.2,"90th_percentile":8752.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":54853.75,"10th_percentile":54853.75,"90th_percentile":54853.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12801.85,"10th_percentile":12801.85,"90th_percentile":12801.85,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7532.28,"maximum":15280.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15280.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10187.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10187.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10706.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7728.29},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7532.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10187.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10187.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8369.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10187.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10187.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10187.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10187.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10187.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10187.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10187.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9639.36},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8614.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10187.25,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":12976.1,"10th_percentile":12976.1,"90th_percentile":12976.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11439.25,"10th_percentile":11439.25,"90th_percentile":11439.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":37646.51,"10th_percentile":37646.51,"90th_percentile":37646.51,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14641.98,"10th_percentile":14641.98,"90th_percentile":14641.98,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4004.54,"10th_percentile":4004.54,"90th_percentile":4004.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":19656.46,"10th_percentile":19656.46,"90th_percentile":19656.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":8509.05,"10th_percentile":8509.05,"90th_percentile":8509.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7770.18,"10th_percentile":7770.18,"90th_percentile":7770.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8421.27,"10th_percentile":8421.27,"90th_percentile":8421.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16855.46,"maximum":30581.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30581.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20387.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20387.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21427.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17294.08},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16855.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20387.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20387.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18728.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20387.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20387.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20387.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20387.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20387.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20387.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20387.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21570.61},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19277.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20387.34,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":16603.26,"10th_percentile":16603.26,"90th_percentile":16603.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":17717.46,"10th_percentile":17717.46,"90th_percentile":17717.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17737.59,"10th_percentile":17737.59,"90th_percentile":17737.59,"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] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":322088.08,"10th_percentile":322088.08,"90th_percentile":322088.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17525.98,"10th_percentile":17525.98,"90th_percentile":17525.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17755.1,"10th_percentile":17755.1,"90th_percentile":17755.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":13063.27,"10th_percentile":8163.7,"90th_percentile":18135.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11234.88,"10th_percentile":11234.88,"90th_percentile":11234.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17762.65,"10th_percentile":17762.65,"90th_percentile":17762.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16426.55,"10th_percentile":16426.55,"90th_percentile":16426.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":17528.54,"10th_percentile":17528.54,"90th_percentile":17528.54,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17717.46,"10th_percentile":17717.46,"90th_percentile":17717.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5583.26,"maximum":11962.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11962.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7975.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7975.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8381.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5728.56},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5583.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7975.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7975.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6203.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7975.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7975.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7975.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7975.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7975.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7975.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7975.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7145.13},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6385.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7975.22,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15282.17,"10th_percentile":15282.17,"90th_percentile":15282.17,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5692.52,"10th_percentile":5692.52,"90th_percentile":5692.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":51011.39,"10th_percentile":51011.39,"90th_percentile":51011.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7061.61,"10th_percentile":7061.61,"90th_percentile":7061.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1752.13,"10th_percentile":1752.13,"90th_percentile":1752.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6169.58,"10th_percentile":6169.58,"90th_percentile":6169.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4720.69,"10th_percentile":4720.69,"90th_percentile":6554.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6819.99,"maximum":14030.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14030.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9353.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9353.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9830.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6997.46},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6819.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9353.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9353.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7577.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9353.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9353.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9353.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9353.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9353.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9353.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9353.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8727.81},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7799.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9353.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8591.36,"10th_percentile":8591.36,"90th_percentile":8591.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8305.79,"10th_percentile":8305.79,"90th_percentile":8305.79,"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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":47133.67,"10th_percentile":47133.67,"90th_percentile":47133.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":8180.3,"10th_percentile":8180.3,"90th_percentile":8180.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":18791.71,"10th_percentile":18791.71,"90th_percentile":18791.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7547.03,"10th_percentile":7547.03,"90th_percentile":7547.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":194.67,"10th_percentile":194.67,"90th_percentile":194.67,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8243.7,"10th_percentile":8243.7,"90th_percentile":8243.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5828.06,"10th_percentile":5828.06,"90th_percentile":5828.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":462.51,"10th_percentile":462.51,"90th_percentile":462.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8315.72,"10th_percentile":8315.72,"90th_percentile":8315.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5467.42,"maximum":11715.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11715.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7810.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7810.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8209.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5609.7},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5467.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7810.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7810.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6074.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7810.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7810.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7810.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7810.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7810.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7810.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7810.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6996.87},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6252.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7810.66,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2215.34,"10th_percentile":2215.34,"90th_percentile":2215.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4379.41,"maximum":9863.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9863.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6911.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":4493.38},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4379.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":4866.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5604.51},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5008.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":5068.4,"10th_percentile":5068.4,"90th_percentile":5913.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":30264.23,"10th_percentile":30264.23,"90th_percentile":30264.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16282.24,"10th_percentile":16282.24,"90th_percentile":16282.24,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6297.9,"10th_percentile":6297.9,"90th_percentile":6297.9,"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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":26975.59,"10th_percentile":26975.59,"90th_percentile":26975.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 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":5362.23,"10th_percentile":5362.23,"90th_percentile":5362.23,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3456.41,"10th_percentile":3456.41,"90th_percentile":3456.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4354.34,"10th_percentile":4354.34,"90th_percentile":4354.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":797.87,"10th_percentile":797.87,"90th_percentile":797.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":5604.51,"10th_percentile":5604.51,"90th_percentile":5604.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5353.32,"10th_percentile":5353.32,"90th_percentile":5353.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5786.77,"maximum":12176.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12176.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8117.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8117.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8531.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5937.36},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5786.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8117.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8117.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6429.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8117.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8117.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8117.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8117.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8117.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8117.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8117.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7405.57},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6618.21},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8117.96,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":12005.32,"10th_percentile":12005.32,"90th_percentile":12005.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5586.65,"10th_percentile":5586.65,"90th_percentile":5586.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6401.26,"10th_percentile":6401.26,"90th_percentile":6401.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":21373.22,"10th_percentile":21373.22,"90th_percentile":25717.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13834.24,"10th_percentile":13834.24,"90th_percentile":13834.24,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":6686.99,"10th_percentile":6686.99,"90th_percentile":6686.99,"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":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":34138.71,"10th_percentile":34138.71,"90th_percentile":34138.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6320.87,"10th_percentile":5507.42,"90th_percentile":7479.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":4209.38,"10th_percentile":4209.38,"90th_percentile":4209.38,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6265.93,"10th_percentile":1562.93,"90th_percentile":7229.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9439.81,"maximum":18563.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18563.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12375.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12375.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13006.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9685.46},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9439.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12375.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12375.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10488.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12375.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12375.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12375.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12375.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12375.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12375.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12375.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12080.5},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10796.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12375.65,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":10386.49,"10th_percentile":9651.84,"90th_percentile":10429.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":27679.57,"10th_percentile":27679.57,"90th_percentile":27679.57,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43946.18,"10th_percentile":43946.18,"90th_percentile":43946.18,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":13112.1,"10th_percentile":13112.1,"90th_percentile":40306.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7107.21,"10th_percentile":7107.21,"90th_percentile":7107.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9044.49,"10th_percentile":6281.18,"90th_percentile":10848.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":10795.22,"10th_percentile":10795.22,"90th_percentile":10795.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10204.24,"10th_percentile":10204.24,"90th_percentile":10204.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7250.49,"maximum":14597.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14597.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9731.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9731.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10228.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7439.17},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7250.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9731.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9731.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8056.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9731.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9731.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9731.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9731.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9731.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9731.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9731.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9278.75},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8292.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9731.76,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":650.08,"10th_percentile":650.08,"90th_percentile":650.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11720.7,"maximum":23633.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23633.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15755.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15755.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16559.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12025.71},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11720.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15755.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15755.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13023.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15755.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15755.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15755.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15755.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15755.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15755.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15755.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14999.46},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13404.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15755.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":12644.4,"10th_percentile":12644.4,"90th_percentile":12644.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":168.28,"10th_percentile":168.28,"90th_percentile":168.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12552.95,"10th_percentile":12552.95,"90th_percentile":12552.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13379.15,"10th_percentile":13379.15,"90th_percentile":13379.15,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5876.01,"maximum":12441.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12441.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8294.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8294.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8717.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6028.92},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5876.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8294.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8294.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6528.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8294.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8294.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8294.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8294.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8294.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8294.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8294.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7519.76},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6720.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8294.34,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9001.29,"10th_percentile":9001.29,"90th_percentile":9001.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":42184.3,"10th_percentile":42184.3,"90th_percentile":42184.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43659.56,"10th_percentile":43659.56,"90th_percentile":43659.56,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5426.22,"10th_percentile":5426.22,"90th_percentile":5426.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7307.5,"10th_percentile":7307.5,"90th_percentile":7307.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":30449.09,"10th_percentile":30449.09,"90th_percentile":31437.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":73.8,"10th_percentile":73.8,"90th_percentile":73.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6057.54,"10th_percentile":6057.54,"90th_percentile":6057.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7134.56,"10th_percentile":7134.56,"90th_percentile":7134.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"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":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5825.61,"10th_percentile":5825.61,"90th_percentile":5825.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":170.0,"10th_percentile":170.0,"90th_percentile":170.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5013.62,"10th_percentile":1003.4,"90th_percentile":7382.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9195.59,"maximum":18372.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18372.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12248.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12248.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12873.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9434.89},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9195.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12248.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12248.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10217.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12248.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12248.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12248.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12248.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12248.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12248.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12248.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11767.97},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10516.81},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12248.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":8080.62,"10th_percentile":8080.62,"90th_percentile":9550.52,"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":8740.44,"10th_percentile":8740.44,"90th_percentile":8740.44,"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] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6976.5,"10th_percentile":6572.2,"90th_percentile":10226.24,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":10022.68,"10th_percentile":10022.68,"90th_percentile":10022.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":49226.33,"10th_percentile":49226.33,"90th_percentile":49226.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8113.29,"10th_percentile":6446.52,"90th_percentile":9745.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10753.82,"10th_percentile":10753.82,"90th_percentile":10753.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10126.01,"10th_percentile":9005.53,"90th_percentile":10152.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5263.12,"maximum":11324.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11324.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7549.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7549.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7934.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5400.08},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5263.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7549.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7549.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5847.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7549.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7549.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7549.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7549.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7549.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7549.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7549.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6735.43},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6019.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7549.72,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9722.31,"10th_percentile":9722.31,"90th_percentile":9722.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 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":16920.12,"10th_percentile":16920.12,"90th_percentile":16920.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":6185.43,"10th_percentile":6185.43,"90th_percentile":6185.43,"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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9104.8,"maximum":18462.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18462.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12308.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12308.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12936.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9341.73},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9104.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12308.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12308.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10116.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12308.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12308.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12308.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12308.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12308.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12308.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12308.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11651.77},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10412.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12308.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9113.62,"10th_percentile":9113.62,"90th_percentile":9113.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5583.26,"maximum":11958.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11958.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7972.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7972.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8379.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5728.56},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5583.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7972.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7972.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6203.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7972.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7972.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7972.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7972.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7972.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7972.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7972.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7145.13},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6385.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7972.49,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":6688.51,"10th_percentile":6688.51,"90th_percentile":6688.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":16612.06,"10th_percentile":16612.06,"90th_percentile":16612.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6503.74,"10th_percentile":6503.74,"90th_percentile":6503.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8379.2,"maximum":16701.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16701.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11134.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11134.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11702.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8597.25},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8379.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11134.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11134.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9310.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11134.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11134.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11134.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11134.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11134.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11134.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11134.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10723.2},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9583.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11134.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9061.64,"10th_percentile":9061.64,"90th_percentile":9061.64,"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":"1 through 10","median_amount":7596.62,"10th_percentile":7596.62,"90th_percentile":7596.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6678.32,"10th_percentile":6678.32,"90th_percentile":6678.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9351.28,"10th_percentile":9351.28,"90th_percentile":9351.28,"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":5250.86,"10th_percentile":5250.86,"90th_percentile":5250.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8035.02,"10th_percentile":8035.02,"90th_percentile":8035.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12662.34,"maximum":24409.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24409.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16273.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16273.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17103.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12991.85},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12662.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16273.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16273.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14069.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16273.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16273.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16273.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16273.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16273.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16273.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16273.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16204.5},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14481.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16273.3,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":13223.54,"10th_percentile":13223.54,"90th_percentile":13223.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12330.51,"10th_percentile":12330.51,"90th_percentile":12330.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7435.79,"10th_percentile":7435.79,"90th_percentile":7435.79,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":26801.26,"10th_percentile":26801.26,"90th_percentile":26801.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":397.56,"10th_percentile":397.56,"90th_percentile":397.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7775.14,"10th_percentile":7775.14,"90th_percentile":7775.14,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14211.99,"10th_percentile":14211.99,"90th_percentile":14211.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12512.82,"10th_percentile":12512.82,"90th_percentile":12512.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained Without Cc/Mcc","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3456.57,"maximum":8350.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8350.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5566.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5566.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5850.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":3546.52},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":3456.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5566.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5566.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":3840.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5566.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5566.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5566.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5566.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5566.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5566.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5566.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4423.51},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":3953.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5566.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Cc","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5513.6,"maximum":10790.00,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10790.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7193.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7193.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7560.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5657.08},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5513.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7193.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7193.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6126.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7193.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7193.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7193.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7193.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7193.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7193.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7193.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7055.97},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6305.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7193.33,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4479.01,"10th_percentile":4479.01,"90th_percentile":4479.01,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12823.58,"maximum":23444.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23444.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15629.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15629.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16426.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13157.29},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12823.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15629.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15629.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14248.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15629.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15629.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15629.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15629.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15629.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15629.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15629.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16410.85},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14666.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15629.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":13643.6,"10th_percentile":13643.6,"90th_percentile":13643.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12678.73,"10th_percentile":12678.73,"90th_percentile":12678.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14055.83,"10th_percentile":14055.83,"90th_percentile":14055.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":85960.53,"10th_percentile":85960.53,"90th_percentile":85960.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11804.28,"10th_percentile":11804.28,"90th_percentile":11804.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13639.18,"10th_percentile":13639.18,"90th_percentile":13639.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis Without Cc/Mcc","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6182.06,"maximum":7911.43,"payers_information":[{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6342.93},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6182.06},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6868.95},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7911.43},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7070.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9611.23,"maximum":12299.87,"payers_information":[{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9861.34},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9611.23},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10679.14},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12299.87},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10992.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10443.25,"10th_percentile":10443.25,"90th_percentile":10443.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4297.23,"maximum":9862.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9862.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6910.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":4409.05},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4297.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":4774.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5499.33},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4914.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.08,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6741.71,"maximum":13722.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13722.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9148.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9148.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9614.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6917.15},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6741.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9148.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9148.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7490.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9148.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9148.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9148.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9148.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9148.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9148.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9148.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8627.64},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7710.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9148.06,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6248.95,"10th_percentile":6248.95,"90th_percentile":6248.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":38025.01,"10th_percentile":38025.01,"90th_percentile":38025.01,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":7859.96,"10th_percentile":7859.96,"90th_percentile":7859.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":31050.36,"10th_percentile":31050.36,"90th_percentile":31050.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4940.24,"10th_percentile":4940.24,"90th_percentile":4940.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5943.13,"10th_percentile":5943.13,"90th_percentile":7022.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7835.81,"10th_percentile":7835.81,"90th_percentile":7835.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7693.51,"10th_percentile":7693.51,"90th_percentile":7693.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8828.14,"10th_percentile":6270.52,"90th_percentile":13784.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11134.39,"10th_percentile":9412.83,"90th_percentile":11369.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11604.97,"10th_percentile":11604.97,"90th_percentile":11604.97,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":23043.61,"10th_percentile":13019.25,"90th_percentile":38120.21,"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":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7682.16,"10th_percentile":7109.17,"90th_percentile":14357.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11354.93,"10th_percentile":11354.93,"90th_percentile":11807.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11034.64,"10th_percentile":11034.64,"90th_percentile":11453.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":37070.86,"10th_percentile":30951.11,"90th_percentile":72724.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11139.83,"10th_percentile":11139.83,"90th_percentile":11148.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"20","median_amount":8111.59,"10th_percentile":3073.46,"90th_percentile":11748.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"24","median_amount":11033.0,"10th_percentile":9332.94,"90th_percentile":11127.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11474.24,"10th_percentile":11474.24,"90th_percentile":11474.24,"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":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10131.6,"10th_percentile":10131.6,"90th_percentile":11354.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5783.97,"10th_percentile":1138.62,"90th_percentile":9401.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11571.45,"10th_percentile":11571.45,"90th_percentile":11571.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4241.83,"10th_percentile":4241.83,"90th_percentile":11722.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":11384.62,"10th_percentile":11384.62,"90th_percentile":11384.62,"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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":9997.51,"10th_percentile":8809.25,"90th_percentile":11148.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7663.0,"maximum":14822.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14822.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9881.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9881.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10385.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7862.41},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7663.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9881.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9881.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8514.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9881.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9881.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9881.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9881.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9881.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9881.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9881.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9806.64},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8764.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9881.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Cc","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12340.63,"maximum":25421.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25421.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16947.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16947.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17812.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12661.77},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12340.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16947.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16947.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13711.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16947.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16947.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16947.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16947.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16947.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16947.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16947.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15792.8},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14113.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16947.91,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12818.33,"10th_percentile":12818.33,"90th_percentile":12818.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21378.9,"maximum":39050.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39050.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26033.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26033.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27361.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21935.23},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21378.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26033.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26033.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23754.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26033.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26033.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26033.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26033.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26033.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26033.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26033.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27359.43},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24450.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26033.34,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":48375.74,"10th_percentile":48375.74,"90th_percentile":48375.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":62722.59,"10th_percentile":62722.59,"90th_percentile":62722.59,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":49318.46,"10th_percentile":48414.5,"90th_percentile":81012.81,"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":14942.02,"10th_percentile":14942.02,"90th_percentile":14942.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7896.91,"10th_percentile":7896.91,"90th_percentile":10890.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9135.34,"10th_percentile":9012.63,"90th_percentile":9399.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8653.87,"10th_percentile":8653.87,"90th_percentile":8653.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9194.7,"10th_percentile":9194.7,"90th_percentile":9194.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12139.25,"10th_percentile":12139.25,"90th_percentile":12139.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":8732.42,"10th_percentile":8732.42,"90th_percentile":8732.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7654.83,"10th_percentile":7637.66,"90th_percentile":9477.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17324.32,"maximum":32321.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32321.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21547.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21547.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22646.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17775.15},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17324.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21547.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21547.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19249.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21547.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21547.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21547.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21547.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21547.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21547.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21547.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22170.63},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19813.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21547.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":26488.32,"10th_percentile":26488.32,"90th_percentile":26488.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":14149.97,"10th_percentile":14149.97,"90th_percentile":14149.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18931.43,"10th_percentile":18931.43,"90th_percentile":18931.43,"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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":64820.02,"10th_percentile":61933.07,"90th_percentile":128499.22,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":58316.72,"10th_percentile":58316.72,"90th_percentile":58316.72,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":13558.4,"10th_percentile":13558.4,"90th_percentile":17014.92,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18541.03,"10th_percentile":18541.03,"90th_percentile":18541.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17995.81,"10th_percentile":17995.81,"90th_percentile":17995.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":62223.07,"10th_percentile":62223.07,"90th_percentile":69084.52,"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":2707.8,"10th_percentile":2707.8,"90th_percentile":2707.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":13565.56,"10th_percentile":13067.2,"90th_percentile":17014.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17931.34,"10th_percentile":15892.53,"90th_percentile":18763.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17121.4,"10th_percentile":17121.4,"90th_percentile":17121.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":39933.16,"10th_percentile":39933.16,"90th_percentile":39933.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18205.11,"10th_percentile":18205.11,"90th_percentile":18205.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired Without Cc/Mcc","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4393.5,"maximum":10311.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10311.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6874.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6874.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7224.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":4507.83},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4393.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6874.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6874.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":4881.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6874.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6874.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6874.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6874.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6874.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6874.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6874.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5622.54},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5024.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6874.2,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5799.3,"maximum":11583.70,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11583.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7722.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7722.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8116.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5950.21},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5799.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7722.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7722.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6443.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7722.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7722.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7722.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7722.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7722.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7722.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7722.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7421.6},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6632.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7722.47,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9392.57,"10th_percentile":9392.57,"90th_percentile":9392.57,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15305.64,"maximum":29157.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29157.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19438.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19438.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20429.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15703.93},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15305.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19438.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19438.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17006.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19438.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19438.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19438.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19438.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19438.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19438.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19438.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19587.24},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17504.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19438.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":14056.69,"10th_percentile":14056.69,"90th_percentile":14056.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16006.03,"10th_percentile":16006.03,"90th_percentile":16006.03,"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":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15903.85,"10th_percentile":15903.85,"90th_percentile":15903.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10947.67,"10th_percentile":10947.67,"90th_percentile":10947.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14348.24,"10th_percentile":14348.24,"90th_percentile":14348.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5675.63,"maximum":12005.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12005.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8411.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5823.32},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5675.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6306.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7263.33},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6491.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8003.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":8818.76,"10th_percentile":8818.76,"90th_percentile":8818.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":543.79,"10th_percentile":543.79,"90th_percentile":543.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45399.04,"10th_percentile":45399.04,"90th_percentile":45399.04,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":6773.31,"10th_percentile":6773.31,"90th_percentile":6773.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":44124.63,"10th_percentile":44124.63,"90th_percentile":46852.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6648.62,"10th_percentile":6648.62,"90th_percentile":6648.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5931.32,"10th_percentile":5931.32,"90th_percentile":5931.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9016.83,"10th_percentile":9016.83,"90th_percentile":9016.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":5585.88,"10th_percentile":5585.88,"90th_percentile":5585.88,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6647.63,"10th_percentile":6647.63,"90th_percentile":6647.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7215.27,"maximum":14678.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14678.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9785.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9785.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10284.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7403.03},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7215.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9785.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9785.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8016.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9785.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9785.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9785.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9785.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9785.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9785.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9785.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9233.67},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8251.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9785.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":10665.0,"10th_percentile":10665.0,"90th_percentile":10665.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":543.79,"10th_percentile":543.79,"90th_percentile":543.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7820.58,"10th_percentile":7820.58,"90th_percentile":8145.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8206.9,"10th_percentile":8206.9,"90th_percentile":8206.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39807.33,"10th_percentile":39807.33,"90th_percentile":65686.35,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7350.02,"10th_percentile":6777.03,"90th_percentile":8496.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in 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":8269.29,"10th_percentile":8269.29,"90th_percentile":12365.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8130.88,"10th_percentile":8130.88,"90th_percentile":8130.88,"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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":53822.56,"10th_percentile":24378.06,"90th_percentile":70288.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":22261.53,"10th_percentile":22261.53,"90th_percentile":22261.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11746.83,"10th_percentile":11746.83,"90th_percentile":11746.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7709.75,"10th_percentile":6703.07,"90th_percentile":8225.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7923.01,"10th_percentile":7923.01,"90th_percentile":7923.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8715.63,"10th_percentile":8715.63,"90th_percentile":8715.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7808.96,"10th_percentile":7808.96,"90th_percentile":7808.96,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":7365.3,"10th_percentile":7365.3,"90th_percentile":7365.3,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":7210.34,"10th_percentile":7210.34,"90th_percentile":7210.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8171.58,"10th_percentile":8171.58,"90th_percentile":8171.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12848.63,"maximum":24019.90,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24019.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16013.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16013.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16829.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13182.98},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12848.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16013.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16013.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14276.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16013.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16013.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16013.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16013.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16013.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16013.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16013.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16442.91},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14694.71},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16013.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1045.01,"10th_percentile":1045.01,"90th_percentile":15073.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13094.73,"10th_percentile":7419.29,"90th_percentile":14136.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12163.45,"10th_percentile":12163.45,"90th_percentile":12163.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":17533.62,"10th_percentile":10602.83,"90th_percentile":20001.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14025.8,"10th_percentile":14025.8,"90th_percentile":14043.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13605.03,"10th_percentile":10236.72,"90th_percentile":13622.47,"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":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":37816.78,"10th_percentile":37816.78,"90th_percentile":61792.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":12204.7,"10th_percentile":12204.7,"90th_percentile":12204.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10885.44,"10th_percentile":9961.99,"90th_percentile":18324.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"18","median_amount":11038.51,"10th_percentile":6752.36,"90th_percentile":13657.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13072.78,"10th_percentile":13072.78,"90th_percentile":13072.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8938.54,"10th_percentile":8938.54,"90th_percentile":60952.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12120.42,"10th_percentile":12120.42,"90th_percentile":12120.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":14551.41,"10th_percentile":14551.41,"90th_percentile":14551.41,"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: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":13493.41,"10th_percentile":11914.25,"90th_percentile":14046.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25080.46,"maximum":51326.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51326.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34217.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34217.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35962.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25733.12},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25080.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34217.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34217.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27867.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34217.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34217.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34217.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34217.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34217.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34217.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34217.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32096.47},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28684.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34217.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39159.55,"maximum":78053.80,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78053.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52035.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52035.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54689.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":40178.59},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39159.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52035.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52035.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43510.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52035.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52035.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52035.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52035.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52035.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52035.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52035.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50114.05},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44785.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52035.87,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37999.66,"10th_percentile":37999.66,"90th_percentile":37999.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36414.49,"maximum":65129.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65129.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43419.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43419.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45633.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":37362.1},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36414.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43419.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43419.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40460.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43419.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43419.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43419.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43419.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43419.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43419.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43419.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46601.09},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41646.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43419.57,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"1 through 10","median_amount":37184.83,"10th_percentile":37184.83,"90th_percentile":37184.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48482.73,"maximum":84059.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84059.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56039.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56039.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58897.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":49744.39},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48482.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56039.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56039.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53869.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56039.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56039.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56039.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56039.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56039.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56039.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56039.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62045.3},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55448.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56039.89,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55312.11,"maximum":99385.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99385.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66257.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66257.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69636.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":56751.49},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55312.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66257.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66257.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":61457.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66257.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66257.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66257.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66257.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66257.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66257.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66257.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70785.13},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63259.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66257.25,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 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":123040.05,"10th_percentile":123040.05,"90th_percentile":123040.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":55280.77,"10th_percentile":55280.77,"90th_percentile":55280.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24427.66,"maximum":47034.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47034.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31356.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31356.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32955.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25063.33},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24427.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31356.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31356.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27141.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31356.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31356.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31356.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31356.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31356.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31356.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31356.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31261.05},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27937.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31356.58,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":25207.38,"10th_percentile":25207.38,"90th_percentile":25207.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":168765.71,"10th_percentile":168765.71,"90th_percentile":168765.71,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":24503.94,"10th_percentile":24503.94,"90th_percentile":24503.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27479.11,"10th_percentile":27479.11,"90th_percentile":29842.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23383.59,"10th_percentile":23383.59,"90th_percentile":23383.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30605.02,"maximum":58405.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58405.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38937.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38937.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40923.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31401.44},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30605.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38937.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38937.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34005.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38937.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38937.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38937.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38937.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38937.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38937.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38937.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39166.47},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35002.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38937.32,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":16362.75,"10th_percentile":16362.75,"90th_percentile":16362.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37475.62,"10th_percentile":37475.62,"90th_percentile":37475.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":37111.46,"10th_percentile":37111.46,"90th_percentile":37111.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":92852.63,"10th_percentile":92852.63,"90th_percentile":92852.63,"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":"1 through 10","median_amount":30357.4,"10th_percentile":30357.4,"90th_percentile":30357.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":22615.31,"10th_percentile":22615.31,"90th_percentile":22615.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29769.18,"10th_percentile":29769.18,"90th_percentile":29945.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19584.08,"maximum":36960.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36960.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24640.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24640.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25897.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20093.71},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19584.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24640.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24640.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21760.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24640.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24640.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24640.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24640.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24640.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24640.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24640.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25062.53},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22397.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24640.48,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":95486.34,"10th_percentile":95486.34,"90th_percentile":95486.34,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":41211.48,"10th_percentile":41211.48,"90th_percentile":41211.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":18350.13,"10th_percentile":18350.13,"90th_percentile":26160.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20231.7,"10th_percentile":20231.7,"90th_percentile":20231.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8207.15,"10th_percentile":8207.15,"90th_percentile":8207.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26960.59,"maximum":50643.40,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50643.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33762.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33762.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35484.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27662.18},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26960.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33762.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33762.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29956.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33762.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33762.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33762.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33762.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33762.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33762.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33762.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34502.55},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30834.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33762.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":111532.73,"10th_percentile":111532.73,"90th_percentile":111532.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":26071.86,"10th_percentile":26071.86,"90th_percentile":37367.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27489.2,"10th_percentile":27489.2,"90th_percentile":27489.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40176.32,"maximum":74100.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74100.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49400.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49400.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51919.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":41221.82},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40176.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49400.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49400.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44640.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49400.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49400.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49400.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49400.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49400.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49400.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49400.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51415.26},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45948.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49400.16,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":40840.51,"10th_percentile":40840.51,"90th_percentile":40840.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39284.18,"10th_percentile":39284.18,"90th_percentile":39284.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":107078.01,"10th_percentile":107078.01,"90th_percentile":107078.01,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":158777.08,"10th_percentile":158777.08,"90th_percentile":250718.93,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":27706.74,"10th_percentile":27706.74,"90th_percentile":27706.74,"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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":119692.18,"10th_percentile":77916.06,"90th_percentile":195295.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":26942.54,"10th_percentile":26942.54,"90th_percentile":26942.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37807.01,"10th_percentile":37807.01,"90th_percentile":39465.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13447.6,"10th_percentile":13447.6,"90th_percentile":13447.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4588.81,"10th_percentile":4588.81,"90th_percentile":4588.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":49086.88,"10th_percentile":49086.88,"90th_percentile":49086.88,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":45950.62,"10th_percentile":45950.62,"90th_percentile":45950.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40833.69,"10th_percentile":18931.68,"90th_percentile":46665.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"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":32564.99,"maximum":59738.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59738.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39825.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39825.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41856.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":33412.42},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32564.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39825.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39825.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36183.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39825.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39825.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39825.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39825.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39825.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39825.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39825.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41674.73},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37243.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39825.59,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52186.64,"maximum":95942.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95942.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63961.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63961.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67223.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":53544.68},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52186.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63961.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63961.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":57985.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63961.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63961.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63961.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63961.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63961.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63961.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63961.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66785.34},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59684.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63961.57,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36823.08,"maximum":67070.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67070.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44713.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44713.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46993.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":37781.32},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36823.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44713.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44713.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40914.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44713.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44713.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44713.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44713.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44713.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44713.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44713.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47123.97},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42113.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44713.34,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46889.08,"maximum":85720.90,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85720.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57147.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57147.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60061.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":48109.26},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46889.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57147.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57147.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52098.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57147.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57147.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57147.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57147.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57147.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57147.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57147.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60005.84},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53626.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57147.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Lead Procedures","code_information":[{"code":"265","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27919.45,"maximum":51487.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51487.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34325.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34325.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36075.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28645.99},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27919.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34325.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34325.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31021.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34325.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34325.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34325.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34325.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34325.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34325.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34325.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35729.64},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31930.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34325.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27355.88,"maximum":47701.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47701.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31801.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31801.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33423.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28067.75},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27355.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31801.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31801.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30395.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31801.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31801.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31801.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31801.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31801.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31801.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31801.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35008.41},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31286.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31801.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":20914.74,"10th_percentile":20914.74,"90th_percentile":20914.74,"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":"1 through 10","median_amount":12686.58,"10th_percentile":12686.58,"90th_percentile":12686.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":67559.36,"10th_percentile":67559.36,"90th_percentile":67559.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":17054.73,"10th_percentile":17054.73,"90th_percentile":18283.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28161.37,"10th_percentile":28161.37,"90th_percentile":28161.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein Ligation And Stripping","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20992.22,"maximum":43839.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43839.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29226.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29226.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30716.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21538.5},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20992.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29226.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29226.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23324.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29226.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29226.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29226.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29226.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29226.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29226.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29226.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26864.59},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24008.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29226.38,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11879.6,"maximum":24371.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24371.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16247.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16247.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17076.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12188.74},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11879.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16247.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16247.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13199.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16247.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16247.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16247.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16247.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16247.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16247.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16247.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15202.8},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13586.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16247.84,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14851.65,"maximum":27925.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27925.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18617.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18617.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19566.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15238.13},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14851.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18617.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18617.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16501.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18617.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18617.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18617.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18617.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18617.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18617.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18617.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19006.26},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16985.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18617.16,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26666.28,"maximum":46504.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46504.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31002.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31002.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32584.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27360.22},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26666.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31002.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31002.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29629.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31002.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31002.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31002.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31002.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31002.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31002.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31002.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34125.92},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30497.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31002.91,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":27170.85,"10th_percentile":27170.85,"90th_percentile":27170.85,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":26525.36,"10th_percentile":26525.36,"90th_percentile":26525.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement Without Mcc","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13757.39,"maximum":29720.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29720.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19813.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19813.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20824.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14115.39},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13757.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19813.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19813.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15285.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19813.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19813.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19813.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19813.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19813.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19813.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19813.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17605.88},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15734.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19813.64,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1052.41,"10th_percentile":1052.41,"90th_percentile":1052.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement With Mcc","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21958.9,"maximum":44994.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44994.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29996.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29996.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31526.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22530.34},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21958.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29996.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29996.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24398.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29996.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29996.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29996.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29996.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29996.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29996.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29996.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28101.69},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25113.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29996.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","code_information":[{"code":"257","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6981.23,"maximum":17038.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17038.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11359.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11359.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11938.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7162.9},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6981.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11359.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11359.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7756.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11359.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11359.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11359.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11359.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11359.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11359.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11359.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8934.16},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7984.29},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11359.19,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13256.43,"maximum":25299.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25299.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16866.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16866.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17726.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13601.4},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13256.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16866.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16866.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14729.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16866.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16866.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16866.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16866.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16866.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16866.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16866.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16964.79},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15161.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16866.08,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":37942.3,"10th_percentile":37942.3,"90th_percentile":37942.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":17519.63,"10th_percentile":17519.63,"90th_percentile":17519.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20478.75,"maximum":38930.00,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38930.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25953.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25953.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27276.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21011.66},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20478.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25953.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25953.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22754.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25953.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25953.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25953.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25953.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25953.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25953.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25953.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26207.48},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23421.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25953.33,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":80409.99,"10th_percentile":80409.99,"90th_percentile":80409.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13692.42,"maximum":26441.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26441.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17627.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17627.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18527.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14048.73},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13692.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17627.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17627.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15213.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17627.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17627.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17627.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17627.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17627.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17627.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17627.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17522.74},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15659.73},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17627.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19982.49,"maximum":37541.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37541.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25027.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25027.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26304.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20502.49},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19982.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25027.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25027.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22202.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25027.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25027.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25027.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25027.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25027.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25027.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25027.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25572.4},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22853.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25027.79,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18993.47,"10th_percentile":18993.47,"90th_percentile":18993.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26849.44,"maximum":49716.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49716.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33144.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33144.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34834.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27548.14},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26849.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33144.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33144.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29832.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33144.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33144.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33144.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33144.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33144.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33144.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33144.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34360.31},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30707.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33144.03,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":32387.17,"10th_percentile":32387.17,"90th_percentile":32387.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":17482.74,"10th_percentile":17482.74,"90th_percentile":17482.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":15112.12,"10th_percentile":15112.12,"90th_percentile":15112.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12230.27,"maximum":22525.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22525.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15016.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15016.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15782.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12548.53},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12230.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15016.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15016.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13589.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15016.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15016.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15016.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15016.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15016.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15016.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15016.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15651.56},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13987.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15016.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":13245.72,"10th_percentile":13245.72,"90th_percentile":13245.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":13395.94,"10th_percentile":13395.94,"90th_percentile":13395.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":15793.39,"10th_percentile":15793.39,"90th_percentile":15793.39,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18102.36,"maximum":31907.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31907.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21271.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21271.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22356.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18573.43},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18102.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21271.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21271.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20113.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21271.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21271.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21271.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21271.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21271.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21271.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21271.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23166.32},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20703.29},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21271.97,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":30084.8,"10th_percentile":28080.1,"90th_percentile":31179.56,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":8090.07,"10th_percentile":8090.07,"90th_percentile":8090.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":102987.23,"10th_percentile":102987.23,"90th_percentile":102987.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":19876.34,"10th_percentile":19876.34,"90th_percentile":19876.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17775.87,"10th_percentile":17775.87,"90th_percentile":17775.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38248.44,"maximum":64364.30,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64364.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42909.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42909.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45097.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":39243.77},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38248.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42909.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42909.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42498.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42909.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42909.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42909.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42909.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42909.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42909.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42909.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48948.07},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43743.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42909.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":131367.36,"10th_percentile":131367.36,"90th_percentile":131367.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14126.05,"maximum":26793.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26793.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17862.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17862.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18773.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14493.65},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14126.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17862.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17862.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15695.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17862.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17862.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17862.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17862.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17862.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17862.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17862.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18077.68},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16155.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17862.55,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11561.83,"10th_percentile":11561.83,"90th_percentile":11561.83,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":50521.85,"10th_percentile":50521.85,"90th_percentile":50521.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15392.51,"10th_percentile":15392.51,"90th_percentile":15392.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12832.51,"10th_percentile":12832.51,"90th_percentile":12832.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17632.72,"maximum":31204.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31204.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20802.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20802.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21863.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18091.57},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17632.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20802.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20802.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20802.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20802.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20802.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20802.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20802.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20802.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20802.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22565.3},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20166.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20802.83,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":13710.87,"10th_percentile":13710.87,"90th_percentile":13710.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15426.46,"10th_percentile":15426.46,"90th_percentile":15426.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":18422.74,"10th_percentile":18422.74,"90th_percentile":18422.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":14017.63,"10th_percentile":14017.63,"90th_percentile":14017.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18159.76,"10th_percentile":17968.66,"90th_percentile":18320.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18495.21,"10th_percentile":18495.21,"90th_percentile":18495.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26550.44,"maximum":45686.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45686.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30457.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30457.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32010.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27241.36},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26550.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30457.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30457.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29500.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30457.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30457.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30457.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30457.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30457.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30457.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30457.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33977.66},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30365.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30457.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":80205.02,"10th_percentile":80205.02,"90th_percentile":80205.02,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":30602.7,"10th_percentile":30602.7,"90th_percentile":30602.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27081.35,"10th_percentile":27081.35,"90th_percentile":27081.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":24844.7,"10th_percentile":24844.7,"90th_percentile":24844.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26119.38,"10th_percentile":26119.38,"90th_percentile":26119.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27349.12,"10th_percentile":27349.12,"90th_percentile":27349.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11817.76,"maximum":21023.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21023.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14015.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14015.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14730.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12125.29},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11817.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14015.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14015.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13130.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14015.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14015.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14015.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14015.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14015.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14015.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14015.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15123.67},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13515.73},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14015.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22793.3,"maximum":41017.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41017.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27345.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27345.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28739.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23386.45},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22793.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27345.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27345.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25325.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27345.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27345.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27345.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27345.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27345.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27345.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27345.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29169.5},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26068.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27345.29,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":16948.71,"10th_percentile":16948.71,"90th_percentile":16948.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21357.84,"10th_percentile":21357.84,"90th_percentile":21357.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39422.55,"maximum":69264.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69264.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46176.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46176.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48531.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":40448.43},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39422.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46176.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46176.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43802.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46176.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46176.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46176.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46176.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46176.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46176.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46176.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50450.62},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45086.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46176.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":21512.61,"10th_percentile":21512.61,"90th_percentile":21512.61,"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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":18549.47,"10th_percentile":18549.47,"90th_percentile":18549.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40038.75,"10th_percentile":40038.75,"90th_percentile":40038.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32184.58,"maximum":59269.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59269.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39512.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39512.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41527.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":33022.11},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32184.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39512.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39512.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35760.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39512.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39512.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39512.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39512.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39512.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39512.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39512.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41187.9},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36808.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39512.83,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46054.68,"maximum":82177.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82177.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54785.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54785.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57579.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":47253.15},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46054.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54785.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54785.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51171.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54785.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54785.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54785.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54785.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54785.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54785.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54785.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58938.02},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52671.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54785.22,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41640.83,"maximum":76642.30,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76642.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51094.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51094.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53700.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":42724.44},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41640.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51094.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51094.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46267.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51094.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51094.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51094.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51094.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51094.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51094.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51094.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53289.44},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47623.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51094.87,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":61177.16,"maximum":106406.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106406.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70937.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70937.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74555.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":62769.16},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61177.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70937.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70937.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":67974.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70937.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70937.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70937.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70937.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70937.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70937.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70937.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78290.87},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69967.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70937.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47811.92,"maximum":84823.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84823.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56549.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56549.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59433.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":49056.12},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47811.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56549.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56549.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53124.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56549.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56549.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56549.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56549.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56549.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56549.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56549.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61186.84},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54681.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56549.03,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":48053.68,"10th_percentile":48053.68,"90th_percentile":48053.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca With Mcc","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":66324.44,"maximum":117108.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":117108.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78072.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78072.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82053.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":68050.38},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66324.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78072.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78072.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":73693.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78072.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78072.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78072.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78072.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78072.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78072.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78072.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84878.05},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75853.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78072.03,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24312.59,"maximum":45095.60,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45095.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30063.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30063.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31596.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24945.28},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24312.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30063.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30063.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27014.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30063.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30063.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30063.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30063.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30063.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30063.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30063.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31113.8},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27805.81},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30063.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24923.24,"10th_percentile":24923.24,"90th_percentile":24923.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":17979.48,"10th_percentile":17979.48,"90th_percentile":17979.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39003.0,"maximum":69614.80,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69614.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46409.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46409.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48776.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":40017.97},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39003.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46409.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46409.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43336.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46409.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46409.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46409.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46409.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46409.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46409.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46409.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49913.71},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44606.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46409.87,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":72460.32,"10th_percentile":72460.32,"90th_percentile":72460.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24708.8,"10th_percentile":24708.8,"90th_percentile":24708.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":44405.12,"10th_percentile":44405.12,"90th_percentile":44405.12,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35945.63,"maximum":70880.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70880.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47253.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47253.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49663.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":36881.04},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35945.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47253.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47253.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39939.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47253.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47253.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47253.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47253.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47253.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47253.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47253.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46001.07},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41110.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47253.58,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41456.1,"maximum":74870.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74870.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49913.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49913.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52459.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":42534.9},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41456.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49913.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49913.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46062.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49913.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49913.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49913.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49913.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49913.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49913.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49913.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53053.04},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47412.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49913.84,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":60560.36,"maximum":106857.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106857.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71238.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71238.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74871.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":62136.31},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60560.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71238.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71238.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":67289.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71238.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71238.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71238.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71238.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71238.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71238.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71238.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77501.53},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69261.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71238.64,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46565.81,"maximum":91815.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91815.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61210.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61210.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64332.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":47777.58},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46565.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61210.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61210.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51739.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61210.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61210.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61210.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61210.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61210.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61210.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61210.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59592.13},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53256.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61210.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50544.46,"maximum":91815.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91815.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61210.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61210.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64332.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":51859.77},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50544.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61210.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61210.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":56160.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61210.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61210.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61210.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61210.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61210.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61210.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61210.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64683.78},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57806.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61210.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":75537.25,"maximum":135558.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":135558.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90372.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90372.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":94981.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":77502.94},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75537.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90372.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90372.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":83930.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90372.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90372.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90372.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90372.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90372.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90372.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90372.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96668.06},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":86390.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90372.32,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Heart Assist System Implant","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":82924.72,"maximum":137934.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":137934.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91956.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91956.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":96645.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":85082.66},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82924.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91956.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91956.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":92138.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91956.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91956.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91956.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91956.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91956.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91956.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91956.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106122.1},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":94839.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91956.11,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":54748.8,"10th_percentile":54748.8,"90th_percentile":54748.8,"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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":82159.26,"10th_percentile":82159.26,"90th_percentile":82354.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31400.97,"10th_percentile":31400.97,"90th_percentile":31400.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Aortic And Mitral Valve Procedures","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":85264.32,"maximum":150441.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150441.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100294.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100294.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":105409.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":87483.14},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":85264.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100294.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100294.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":94738.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100294.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100294.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100294.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100294.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100294.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100294.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100294.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":109116.18},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":97515.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100294.19,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":21608.06,"10th_percentile":21608.06,"90th_percentile":21608.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":98517.04,"10th_percentile":98517.04,"90th_percentile":98517.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21622.29,"10th_percentile":21622.29,"90th_percentile":22013.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":900.25,"10th_percentile":900.25,"90th_percentile":900.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21830.83,"10th_percentile":21168.11,"90th_percentile":21859.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50625.08,"maximum":89898.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89898.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59932.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59932.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62988.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":51942.49},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":50625.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59932.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59932.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":56250.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59932.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59932.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59932.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59932.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59932.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59932.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59932.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64786.95},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57898.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59932.09,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49424.12,"10th_percentile":49424.12,"90th_percentile":49424.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7090.03,"maximum":14978.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14978.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9985.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9985.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10494.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7274.53},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7090.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9985.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9985.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7877.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9985.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9985.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9985.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9985.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9985.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9985.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9985.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9073.4},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8108.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9985.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":229.73,"10th_percentile":229.73,"90th_percentile":229.73,"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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":374.07,"10th_percentile":374.07,"90th_percentile":374.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6958.55,"10th_percentile":6958.55,"90th_percentile":6958.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7580.77,"10th_percentile":7580.77,"90th_percentile":7580.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14775.73,"maximum":27114.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27114.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18076.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18076.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18998.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15160.23},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14775.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18076.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18076.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16417.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18076.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18076.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18076.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18076.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18076.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18076.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18076.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18909.09},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16898.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18076.2,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":14766.8,"10th_percentile":14766.8,"90th_percentile":14766.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":18289.51,"10th_percentile":18289.51,"90th_percentile":18289.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":25273.17,"10th_percentile":25273.17,"90th_percentile":25273.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7877.1,"10th_percentile":7877.1,"90th_percentile":7877.1,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6347.21,"maximum":13154.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13154.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8769.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8769.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9217.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6512.39},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6347.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8769.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8769.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7052.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8769.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8769.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8769.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8769.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8769.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8769.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8769.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8122.79},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7259.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8769.84,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5450.2,"maximum":11280.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11280.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7520.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7520.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7904.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5592.03},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5450.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7520.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7520.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6055.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7520.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7520.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7520.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7520.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7520.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7520.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7520.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6974.84},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6233.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7520.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":17444.87,"10th_percentile":17444.87,"90th_percentile":17444.87,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4242.59,"10th_percentile":4242.59,"90th_percentile":4242.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6555.36,"10th_percentile":6555.36,"90th_percentile":6555.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":22343.45,"10th_percentile":22343.45,"90th_percentile":22343.45,"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":"1 through 10","median_amount":5664.64,"10th_percentile":5664.64,"90th_percentile":5664.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3363.78,"10th_percentile":3363.78,"90th_percentile":3363.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7566.72,"maximum":15388.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15388.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10259.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10259.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10782.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7763.63},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7566.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10259.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10259.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8407.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10259.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10259.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10259.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10259.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10259.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10259.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10259.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9683.43},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8653.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10259.08,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7794.18,"10th_percentile":7794.18,"90th_percentile":7794.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3766.48,"10th_percentile":3766.48,"90th_percentile":3766.48,"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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":65200.51,"10th_percentile":65200.51,"90th_percentile":65200.51,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30798.39,"10th_percentile":30798.39,"90th_percentile":30798.39,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5947.38,"10th_percentile":5410.86,"90th_percentile":6421.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7296.15,"10th_percentile":7296.15,"90th_percentile":7296.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8435.27,"10th_percentile":8435.27,"90th_percentile":8435.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":35822.83,"10th_percentile":35822.83,"90th_percentile":35822.83,"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":8933.65,"10th_percentile":8933.65,"90th_percentile":8933.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6123.22,"10th_percentile":6123.22,"90th_percentile":6123.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8830.24,"10th_percentile":8436.74,"90th_percentile":9021.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6556.84,"10th_percentile":6091.47,"90th_percentile":15036.19,"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":"1 through 10","median_amount":6864.53,"10th_percentile":6864.53,"90th_percentile":6864.53,"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":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":9683.43,"10th_percentile":9683.43,"90th_percentile":9683.43,"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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":194.67,"10th_percentile":194.67,"90th_percentile":194.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5298.35,"maximum":11896.00,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11896.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7930.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7930.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8335.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5436.22},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5298.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7930.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7930.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5887.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7930.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7930.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7930.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7930.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7930.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7930.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7930.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6780.51},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6059.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7930.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6971.89,"10th_percentile":6971.89,"90th_percentile":6971.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8668.03,"maximum":17135.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17135.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11423.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11423.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12006.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8893.6},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8668.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11423.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11423.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9631.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11423.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11423.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11423.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11423.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11423.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11423.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11423.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11092.83},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9913.44},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11423.74,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":7065.92,"10th_percentile":7065.92,"90th_percentile":7065.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23564.32,"10th_percentile":23564.32,"90th_percentile":23564.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7719.42,"10th_percentile":7719.42,"90th_percentile":7719.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3045.19,"10th_percentile":3045.19,"90th_percentile":3045.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13816.87,"maximum":26201.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26201.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17467.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17467.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18358.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14176.43},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13816.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17467.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17467.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15352.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17467.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17467.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17467.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17467.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17467.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17467.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17467.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17682.01},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15802.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17467.96,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":124758.67,"10th_percentile":124758.67,"90th_percentile":124758.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13553.84,"10th_percentile":13553.84,"90th_percentile":13553.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5482.29,"maximum":11911.00,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11911.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7940.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7940.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8345.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5624.95},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5482.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7940.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7940.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6091.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7940.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7940.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7940.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7940.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7940.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7940.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7940.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7015.91},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6269.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7940.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5866.09,"10th_percentile":5866.09,"90th_percentile":5866.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7748.31,"maximum":15087.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15087.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10058.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10058.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10571.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7949.95},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7748.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10058.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10058.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8609.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10058.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10058.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10058.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10058.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10058.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10058.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10058.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9915.83},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8861.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10058.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":14794.45,"10th_percentile":14794.45,"90th_percentile":14794.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14908.12,"10th_percentile":14908.12,"90th_percentile":14908.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4874.89,"maximum":10714.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10714.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7143.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7143.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7507.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5001.74},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4874.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7143.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7143.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5416.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7143.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7143.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7143.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7143.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7143.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7143.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7143.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6238.59},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5575.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7143.32,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5419.98,"10th_percentile":5419.98,"90th_percentile":5419.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5843.56,"10th_percentile":5843.56,"90th_percentile":5843.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29722.39,"10th_percentile":29722.39,"90th_percentile":29722.39,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4846.99,"10th_percentile":4846.99,"90th_percentile":4846.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":29420.36,"10th_percentile":29420.36,"90th_percentile":29420.36,"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":"1 through 10","median_amount":5174.04,"10th_percentile":5174.04,"90th_percentile":5174.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5687.15,"10th_percentile":5687.15,"90th_percentile":5687.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5795.16,"10th_percentile":5795.16,"90th_percentile":5795.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4987.21,"10th_percentile":4987.21,"90th_percentile":4987.21,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6418.44,"maximum":13134.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13134.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9202.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6585.47},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6418.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7131.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8213.94},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7340.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8756.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":6852.87,"10th_percentile":6852.87,"90th_percentile":6852.87,"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":7983.64,"10th_percentile":7983.64,"90th_percentile":7983.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7388.31,"10th_percentile":7388.31,"90th_percentile":7785.3,"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":"1 through 10","median_amount":6454.13,"10th_percentile":6454.13,"90th_percentile":6454.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":48557.62,"10th_percentile":48557.62,"90th_percentile":48557.62,"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":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10424.26,"10th_percentile":10424.26,"90th_percentile":10424.26,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7139.21,"10th_percentile":7139.21,"90th_percentile":7139.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":7298.7,"10th_percentile":7298.7,"90th_percentile":7298.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":43665.87,"10th_percentile":43665.87,"90th_percentile":43665.87,"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":6223.37,"10th_percentile":6223.37,"90th_percentile":6223.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5667.78,"10th_percentile":5133.9,"90th_percentile":7468.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":7339.74,"10th_percentile":858.98,"90th_percentile":7712.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5559.96,"10th_percentile":3740.24,"90th_percentile":6939.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10314.91,"maximum":20069.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20069.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13379.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13379.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14061.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10583.33},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10314.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13379.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13379.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11461.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13379.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13379.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13379.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13379.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13379.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13379.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13379.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13200.4},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11796.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13379.38,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":10429.05,"10th_percentile":10429.05,"90th_percentile":10429.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3312.76,"10th_percentile":383.18,"90th_percentile":11776.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11248.5,"10th_percentile":11248.5,"90th_percentile":11248.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10852.59,"10th_percentile":10852.59,"90th_percentile":10852.59,"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] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":72891.41,"10th_percentile":72891.41,"90th_percentile":72891.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18086.17,"10th_percentile":18086.17,"90th_percentile":18086.17,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7319.95,"10th_percentile":6746.96,"90th_percentile":14575.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11478.16,"10th_percentile":11478.16,"90th_percentile":11478.16,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11133.82,"10th_percentile":11133.82,"90th_percentile":11133.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":33090.62,"10th_percentile":20559.97,"90th_percentile":62979.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14738.82,"10th_percentile":14738.82,"90th_percentile":14738.82,"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":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9611.91,"10th_percentile":6746.96,"90th_percentile":10835.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11182.36,"10th_percentile":7313.69,"90th_percentile":11714.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11137.62,"10th_percentile":11137.62,"90th_percentile":11714.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7892.94,"10th_percentile":7319.95,"90th_percentile":11164.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9767.4,"10th_percentile":9767.4,"90th_percentile":9767.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":13199.4,"10th_percentile":13199.4,"90th_percentile":13199.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":12601.17,"10th_percentile":12601.17,"90th_percentile":12601.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10087.3,"10th_percentile":5547.04,"90th_percentile":11813.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5065.87,"maximum":10899.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10899.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7266.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7266.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7636.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5197.7},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5065.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7266.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7266.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5628.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7266.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7266.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7266.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7266.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7266.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7266.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7266.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6483.0},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5793.73},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7266.06,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7057.88,"10th_percentile":7057.88,"90th_percentile":7057.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6724.49,"maximum":13640.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13640.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9093.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9093.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9557.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6899.48},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6724.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9093.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9093.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7471.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9093.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9093.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9093.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9093.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9093.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9093.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9093.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8605.6},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7690.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9093.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4724.22,"10th_percentile":4724.22,"90th_percentile":4724.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8079.22,"10th_percentile":8079.22,"90th_percentile":8079.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6167.47,"10th_percentile":6167.47,"90th_percentile":6798.72,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":7996.78,"10th_percentile":7996.78,"90th_percentile":7996.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 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":5946.11,"10th_percentile":5946.11,"90th_percentile":5946.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6587.84,"10th_percentile":6587.84,"90th_percentile":6587.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7614.1,"10th_percentile":7614.1,"90th_percentile":7614.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7203.23,"10th_percentile":7203.23,"90th_percentile":7203.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6525.16,"10th_percentile":6525.16,"90th_percentile":7686.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8792.48,"maximum":17250.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17250.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11500.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11500.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12086.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9021.29},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8792.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11500.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11500.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9769.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11500.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11500.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11500.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11500.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11500.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11500.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11500.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11252.1},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10055.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11500.11,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11217.59,"10th_percentile":11217.59,"90th_percentile":11217.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10176.29,"10th_percentile":10176.29,"90th_percentile":10176.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7104.54,"10th_percentile":7104.54,"90th_percentile":8342.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10383.97,"10th_percentile":10383.97,"90th_percentile":10383.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":71656.73,"10th_percentile":71656.73,"90th_percentile":71656.73,"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":"1 through 10","median_amount":9067.62,"10th_percentile":9067.62,"90th_percentile":9067.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":308.87,"10th_percentile":308.87,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9273.8,"10th_percentile":7419.37,"90th_percentile":12136.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9302.34,"10th_percentile":9302.34,"90th_percentile":9302.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9548.58,"10th_percentile":9548.58,"90th_percentile":9548.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10831.21,"10th_percentile":10831.21,"90th_percentile":10831.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9686.37,"maximum":18991.70,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18991.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12661.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12661.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13306.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9938.44},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9686.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12661.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12661.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10762.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12661.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12661.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12661.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12661.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12661.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12661.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12661.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12396.04},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11078.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12661.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":15767.23,"10th_percentile":15767.23,"90th_percentile":15767.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7820.28,"10th_percentile":7075.61,"90th_percentile":9741.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7672.92,"10th_percentile":7672.92,"90th_percentile":7672.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":26597.5,"10th_percentile":26597.5,"90th_percentile":26597.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":85399.45,"10th_percentile":85399.45,"90th_percentile":85399.45,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8382.06,"10th_percentile":6504.62,"90th_percentile":10737.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10828.15,"10th_percentile":10828.15,"90th_percentile":10828.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11073.84,"10th_percentile":11073.84,"90th_percentile":11073.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":15535.3,"10th_percentile":15535.3,"90th_percentile":42306.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13619.12,"10th_percentile":13619.12,"90th_percentile":13619.12,"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":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":35722.36,"10th_percentile":35722.36,"90th_percentile":35722.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":10564.36,"10th_percentile":7610.47,"90th_percentile":11094.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9405.74,"10th_percentile":7686.77,"90th_percentile":10406.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10638.88,"10th_percentile":10638.88,"90th_percentile":10638.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8788.79,"10th_percentile":6898.72,"90th_percentile":10611.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5746.07,"maximum":11924.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11924.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8355.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5895.6},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5746.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6384.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7353.48},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6571.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.76,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7857.9,"maximum":15632.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15632.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10421.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10421.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10953.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8062.38},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7857.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10421.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10421.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8731.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10421.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10421.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10421.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10421.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10421.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10421.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10421.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10056.07},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8986.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10421.82,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12367.24,"maximum":23398.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23398.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15598.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15598.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16394.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12689.07},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12367.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15598.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15598.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13741.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15598.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15598.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15598.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15598.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15598.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15598.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15598.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15826.86},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14144.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15598.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13259.19,"10th_percentile":13259.19,"90th_percentile":13259.19,"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] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":40323.66,"10th_percentile":40323.66,"90th_percentile":40323.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6086.56,"maximum":12869.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12869.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8579.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8579.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9017.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6244.95},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6086.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8579.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8579.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6762.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8579.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8579.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8579.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8579.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8579.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8579.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8579.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7789.22},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6961.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8579.82,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6807.64,"10th_percentile":6807.64,"90th_percentile":6807.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8359.63,"maximum":16655.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16655.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11103.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11103.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11670.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8577.17},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8359.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11103.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11103.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9288.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11103.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11103.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11103.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11103.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11103.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11103.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11103.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10698.16},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9560.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11103.71,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":8705.02,"10th_percentile":8705.02,"90th_percentile":8705.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":9499.84,"10th_percentile":9499.84,"90th_percentile":9499.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":10336.55,"10th_percentile":10336.55,"90th_percentile":10336.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12423.6,"maximum":23007.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23007.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15338.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15338.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16120.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12746.9},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12423.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15338.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15338.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13804.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15338.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15338.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15338.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15338.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15338.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15338.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15338.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15898.98},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14208.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15338.66,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10425.37,"10th_percentile":10425.37,"90th_percentile":10425.37,"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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms Without Cc/Mcc","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6555.42,"maximum":12423.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12423.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8282.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8282.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8704.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6726.01},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6555.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8282.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8282.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7283.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8282.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8282.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8282.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8282.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8282.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8282.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8282.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8389.24},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7497.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8282.52,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8689.95,"maximum":16749.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16749.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11166.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11166.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11735.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8916.08},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8689.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11166.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11166.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9655.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11166.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11166.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11166.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11166.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11166.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11166.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11166.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11120.87},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9938.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11166.44,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13679.89,"maximum":26227.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26227.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17485.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17485.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18376.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14035.88},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13679.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17485.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17485.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15199.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17485.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17485.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17485.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17485.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17485.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17485.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17485.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17506.71},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15645.41},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17485.24,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":85302.33,"10th_percentile":85302.33,"90th_percentile":85302.33,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8093.66,"10th_percentile":8093.66,"90th_percentile":8093.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10414.32,"10th_percentile":10414.32,"90th_percentile":17609.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14434.77,"10th_percentile":14243.67,"90th_percentile":14464.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":14398.24,"10th_percentile":14398.24,"90th_percentile":14398.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6024.73,"maximum":12440.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12440.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8716.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6181.51},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6024.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6694.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7710.08},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6890.35},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7942.31,"10th_percentile":7942.31,"90th_percentile":7942.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7324.86,"10th_percentile":7324.86,"90th_percentile":7324.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7765.53,"maximum":15454.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15454.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10302.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10302.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10828.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7967.61},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7765.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10302.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10302.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8628.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10302.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10302.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10302.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10302.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10302.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10302.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10302.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9937.87},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8881.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10302.72,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":8442.53,"10th_percentile":8442.53,"90th_percentile":8442.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8719.42,"10th_percentile":8719.42,"90th_percentile":8719.42,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":9319.29,"10th_percentile":9319.29,"90th_percentile":9319.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8630.55,"10th_percentile":8630.55,"90th_percentile":8630.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":100793.68,"10th_percentile":100793.68,"90th_percentile":100793.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11550.19,"10th_percentile":6781.15,"90th_percentile":12592.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6892.07,"10th_percentile":6892.07,"90th_percentile":6892.07,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8266.4,"10th_percentile":8266.4,"90th_percentile":8266.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10873.08,"10th_percentile":10873.08,"90th_percentile":10873.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12652.94,"maximum":23455.30,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23455.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15636.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15636.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16434.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12982.21},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12652.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15636.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15636.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14058.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15636.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15636.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15636.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15636.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15636.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15636.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15636.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16192.48},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14470.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15636.87,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":13016.57,"10th_percentile":13016.57,"90th_percentile":13016.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11451.85,"10th_percentile":11451.85,"90th_percentile":13781.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13230.4,"10th_percentile":13230.4,"90th_percentile":13569.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8688.13,"10th_percentile":8281.64,"90th_percentile":9831.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9373.36,"10th_percentile":8663.52,"90th_percentile":13820.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13431.03,"10th_percentile":13431.03,"90th_percentile":13431.03,"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":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13195.73,"10th_percentile":13195.73,"90th_percentile":13195.73,"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":11294.71,"10th_percentile":9601.22,"90th_percentile":11472.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":11258.39,"10th_percentile":6231.48,"90th_percentile":15098.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14062.28,"10th_percentile":14062.28,"90th_percentile":14062.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12699.06,"10th_percentile":12699.06,"90th_percentile":12699.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11909.65,"10th_percentile":11909.65,"90th_percentile":11909.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":14835.55,"10th_percentile":14835.55,"90th_percentile":14835.55,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8247.28,"10th_percentile":8247.28,"90th_percentile":11746.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6375.39,"maximum":13122.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13122.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8748.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8748.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9194.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6541.3},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6375.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8748.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8748.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7083.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8748.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8748.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8748.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8748.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8748.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8748.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8748.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8158.85},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7291.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8748.02,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":7778.17,"10th_percentile":7778.17,"90th_percentile":7778.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":32598.68,"10th_percentile":32598.68,"90th_percentile":32598.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24082.64,"10th_percentile":24082.64,"90th_percentile":24082.64,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":7252.43,"10th_percentile":7252.43,"90th_percentile":7252.43,"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":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":27200.51,"10th_percentile":27200.51,"90th_percentile":30279.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7052.82,"10th_percentile":7052.82,"90th_percentile":7052.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":7764.06,"10th_percentile":7764.06,"90th_percentile":7764.06,"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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11029.55,"maximum":20876.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20876.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13917.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13917.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14627.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11316.57},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11029.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13917.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13917.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12255.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13917.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13917.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13917.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13917.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13917.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13917.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13917.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14114.95},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12614.26},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13917.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":2323.2,"10th_percentile":2323.2,"90th_percentile":2323.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12453.45,"10th_percentile":12453.45,"90th_percentile":12453.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11943.41,"10th_percentile":11943.41,"90th_percentile":11943.41,"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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10290.97,"10th_percentile":10290.97,"90th_percentile":10290.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12187.15,"10th_percentile":12187.15,"90th_percentile":12187.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":220.87,"10th_percentile":220.87,"90th_percentile":220.87,"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":"1 through 10","median_amount":11833.9,"10th_percentile":7090.71,"90th_percentile":12178.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11839.87,"10th_percentile":11839.87,"90th_percentile":11839.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11022.21,"10th_percentile":11022.21,"90th_percentile":11022.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"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":24017.5,"maximum":42734.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42734.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28489.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28489.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29942.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24642.5},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24017.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28489.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28489.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26686.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28489.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28489.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28489.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28489.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28489.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28489.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28489.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30736.16},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27468.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28489.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":30856.07,"10th_percentile":30856.07,"90th_percentile":30856.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":95821.73,"10th_percentile":94521.77,"90th_percentile":160110.18,"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":"1 through 10","median_amount":15897.04,"10th_percentile":15897.04,"90th_percentile":15897.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24506.64,"10th_percentile":24506.64,"90th_percentile":24506.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24837.41,"10th_percentile":24837.41,"90th_percentile":24837.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10596.69,"maximum":20778.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20778.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13852.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13852.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14558.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10872.45},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10596.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13852.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13852.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11774.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13852.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13852.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13852.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13852.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13852.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13852.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13852.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13561.01},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12119.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13852.16,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14301.39,"maximum":26737.90,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26737.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17825.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17825.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18734.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14673.55},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14301.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17825.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17825.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15890.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17825.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17825.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17825.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17825.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17825.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17825.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17825.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18302.06},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16356.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17825.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13519.72,"10th_percentile":13519.72,"90th_percentile":13519.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13606.73,"10th_percentile":13606.73,"90th_percentile":13606.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30143.2,"maximum":53117.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53117.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35411.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35411.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37217.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30927.61},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30143.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35411.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35411.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33492.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35411.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35411.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35411.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35411.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35411.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35411.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35411.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38575.47},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34474.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35411.52,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":46823.33,"10th_percentile":46823.33,"90th_percentile":46823.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12126.07,"10th_percentile":12126.07,"90th_percentile":27333.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30729.46,"10th_percentile":30729.46,"90th_percentile":30729.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14589.43,"maximum":28248.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28248.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18832.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18832.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19793.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14969.09},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14589.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18832.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18832.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16210.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18832.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18832.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18832.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18832.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18832.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18832.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18832.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18670.69},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16685.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18832.64,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19699.92,"maximum":36565.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36565.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24376.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24376.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25620.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20212.57},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19699.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24376.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24376.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21888.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24376.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24376.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24376.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24376.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24376.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24376.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24376.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25210.79},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22530.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24376.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":230.05,"10th_percentile":230.05,"90th_percentile":230.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":18636.46,"10th_percentile":18636.46,"90th_percentile":18636.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36075.57,"maximum":63265.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63265.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42176.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42176.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44327.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":37014.35},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36075.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42176.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42176.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40083.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42176.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42176.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42176.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42176.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42176.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42176.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42176.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46167.35},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41258.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42176.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":139336.82,"10th_percentile":139336.82,"90th_percentile":139336.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8572.0,"10th_percentile":8572.0,"90th_percentile":8572.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23943.98,"10th_percentile":23943.98,"90th_percentile":23943.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11307.47,"10th_percentile":11307.47,"90th_percentile":11307.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":94600.63,"10th_percentile":94600.63,"90th_percentile":94600.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8572.0,"10th_percentile":8572.0,"90th_percentile":8572.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the 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":12828.08,"10th_percentile":12828.08,"90th_percentile":12828.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35084.81,"10th_percentile":35084.81,"90th_percentile":35084.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases Without Cc/Mcc","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5162.93,"maximum":11806.00,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11806.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8272.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5297.29},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5162.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5736.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6607.21},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5904.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7870.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":6134.29,"10th_percentile":6134.29,"90th_percentile":6134.29,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7361.64,"maximum":14551.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14551.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9700.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9700.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10195.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7553.21},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7361.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9700.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9700.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8179.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9700.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9700.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9700.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9700.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9700.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9700.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9700.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9420.99},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8419.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9700.84,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":8608.44,"10th_percentile":8608.44,"90th_percentile":8608.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":27012.25,"10th_percentile":27012.25,"90th_percentile":27012.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5225.67,"10th_percentile":5225.67,"90th_percentile":5225.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12816.54,"maximum":25556.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25556.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17037.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17037.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17906.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13150.06},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12816.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17037.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17037.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14240.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17037.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17037.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17037.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17037.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17037.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17037.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17037.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16401.84},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14658.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17037.92,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5419.15,"10th_percentile":5419.15,"90th_percentile":5419.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5263.12,"maximum":11568.70,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11568.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7712.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7712.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8105.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5400.08},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5263.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7712.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7712.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5847.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7712.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7712.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7712.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7712.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7712.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7712.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7712.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6735.43},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6019.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7712.47,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4934.89,"10th_percentile":4934.89,"90th_percentile":4934.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4934.89,"10th_percentile":4934.89,"90th_percentile":4934.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7307.63,"maximum":14642.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14642.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9761.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9761.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10259.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7497.8},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7307.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9761.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9761.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8119.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9761.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9761.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9761.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9761.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9761.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9761.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9761.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9351.87},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8357.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9761.76,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26710.68,"10th_percentile":26710.68,"90th_percentile":26710.68,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9376.41,"10th_percentile":9376.41,"90th_percentile":9376.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7559.0,"10th_percentile":7559.0,"90th_percentile":7559.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12728.87,"maximum":23466.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23466.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15644.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15644.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16442.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13060.11},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12728.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15644.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15644.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14143.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15644.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15644.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15644.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15644.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15644.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15644.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15644.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16289.65},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14557.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15644.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13147.17,"10th_percentile":13147.17,"90th_percentile":13147.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5570.74,"maximum":12211.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12211.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8140.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8140.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8555.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5715.71},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5570.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8140.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8140.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6189.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8140.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8140.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8140.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8140.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8140.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8140.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8140.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7129.1},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6371.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8140.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28908.13,"10th_percentile":28908.13,"90th_percentile":28908.13,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2964.99,"10th_percentile":2964.99,"90th_percentile":2964.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":20201.65,"10th_percentile":20201.65,"90th_percentile":20201.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4887.3,"10th_percentile":4887.3,"90th_percentile":4887.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8881.72,"maximum":18266.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18266.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12177.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12177.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12798.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9112.84},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8881.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12177.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12177.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9868.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12177.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12177.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12177.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12177.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12177.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12177.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12177.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11366.29},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10157.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12177.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":15015.38,"10th_percentile":15015.38,"90th_percentile":15015.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4008.49,"10th_percentile":4008.49,"90th_percentile":4008.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":658.06,"10th_percentile":658.06,"90th_percentile":658.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5933.15,"maximum":12153.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12153.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8102.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8102.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8515.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6087.54},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5933.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8102.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8102.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6592.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8102.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8102.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8102.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8102.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8102.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8102.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8102.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7592.89},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6785.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8102.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":6142.01,"10th_percentile":6142.01,"90th_percentile":6142.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis With Mcc","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10818.21,"maximum":20302.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20302.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13534.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13534.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14225.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11099.73},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10818.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13534.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13534.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12020.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13534.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13534.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13534.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13534.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13534.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13534.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13534.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13844.5},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12372.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13534.85,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36828.25,"10th_percentile":36828.25,"90th_percentile":36828.25,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5850.96,"maximum":12393.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12393.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8262.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8262.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8683.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6003.22},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5850.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8262.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8262.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6501.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8262.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8262.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8262.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8262.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8262.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8262.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8262.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7487.71},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6691.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8262.52,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":312.51,"10th_percentile":312.51,"90th_percentile":312.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6267.38,"maximum":13014.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13014.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8676.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8676.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9118.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6430.47},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6267.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8676.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8676.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6963.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8676.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8676.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8676.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8676.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8676.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8676.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8676.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8020.61},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7167.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8676.2,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Cc","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9742.73,"maximum":19484.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19484.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12989.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12989.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13651.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9996.26},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9742.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12989.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12989.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10825.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12989.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12989.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12989.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12989.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12989.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12989.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12989.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12468.16},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11142.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12989.34,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Mcc","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17955.2,"maximum":31020.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31020.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20680.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20680.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21734.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18422.45},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17955.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20680.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20680.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19950.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20680.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20680.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20680.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20680.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20680.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20680.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20680.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22978.0},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20534.99},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20680.09,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9273.09,"maximum":18540.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18540.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12360.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12360.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12990.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9514.4},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9273.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12360.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12360.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10303.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12360.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12360.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12360.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12360.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12360.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12360.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12360.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11867.14},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10605.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12360.19,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":46818.5,"10th_percentile":46818.5,"90th_percentile":46818.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":10159.16,"10th_percentile":10159.16,"90th_percentile":10159.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","code_information":[{"code":"144","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13749.56,"maximum":25776.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25776.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17184.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17184.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18060.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14107.36},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13749.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17184.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17184.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15277.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17184.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17184.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17184.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17184.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17184.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17184.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17184.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17595.86},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15725.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17184.3,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","code_information":[{"code":"143","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25843.63,"maximum":53238.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53238.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35492.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35492.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37302.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26516.15},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25843.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35492.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35492.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28715.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35492.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35492.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35492.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35492.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35492.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35492.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35492.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33073.13},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29556.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35492.44,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1542.72,"10th_percentile":1542.72,"90th_percentile":1542.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12306.97,"maximum":23914.90,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23914.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15943.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15943.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16756.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12627.24},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12306.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15943.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15943.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13674.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15943.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15943.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15943.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15943.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15943.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15943.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15943.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15749.73},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14075.23},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15943.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16815.54,"maximum":31888.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31888.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21259.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21259.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22343.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17253.13},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16815.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21259.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21259.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18683.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21259.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21259.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21259.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21259.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21259.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21259.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21259.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21519.52},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19231.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21259.24,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33101.95,"maximum":60312.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60312.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40208.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40208.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42258.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":33963.35},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33101.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40208.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40208.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36779.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40208.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40208.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40208.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40208.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40208.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40208.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40208.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42361.89},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37858.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40208.35,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10746.2,"maximum":18995.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18995.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13309.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11025.84},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10746.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11940.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13752.34},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12290.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.86,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures Without Cc/Mcc","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6367.57,"maximum":14229.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14229.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9486.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9486.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9970.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6533.27},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6367.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9486.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9486.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7075.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9486.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9486.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9486.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9486.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9486.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9486.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9486.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8148.83},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7282.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9486.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures With Cc/Mcc","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10946.58,"maximum":22507.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22507.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15004.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15004.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15770.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11231.44},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10946.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15004.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15004.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12162.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15004.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15004.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15004.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15004.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15004.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15004.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15004.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14008.77},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12519.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15004.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures Without Cc/Mcc","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7656.73,"maximum":15990.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15990.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10660.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10660.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11203.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7855.98},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7656.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10660.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10660.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8507.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10660.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10660.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10660.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10660.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10660.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10660.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10660.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9798.63},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8756.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10660.03,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures With Cc/Mcc","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18871.01,"maximum":31737.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31737.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21158.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21158.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22237.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19362.08},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18871.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21158.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21158.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20967.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21158.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21158.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21158.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21158.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21158.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21158.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21158.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24149.99},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21582.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21158.32,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6463.06,"maximum":12614.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12614.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8409.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8409.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8838.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6631.25},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6463.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8409.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8409.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7181.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8409.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8409.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8409.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8409.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8409.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8409.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8409.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8271.04},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7391.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8409.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6137.97,"10th_percentile":6137.97,"90th_percentile":6137.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5591.23,"10th_percentile":5591.23,"90th_percentile":5591.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"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":10205.33,"maximum":20187.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20187.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13458.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13458.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14144.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10470.9},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10205.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13458.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13458.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11339.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13458.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13458.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13458.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13458.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13458.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13458.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13458.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13060.16},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11671.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13458.48,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6286.94,"maximum":13034.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13034.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8689.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8689.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9133.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6450.55},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6286.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8689.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8689.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6985.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8689.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8689.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8689.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8689.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8689.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8689.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8689.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8045.65},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7190.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8689.84,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":169.72,"10th_percentile":169.72,"90th_percentile":169.72,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5309.31,"maximum":12860.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12860.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8573.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8573.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9010.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5447.47},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5309.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8573.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8573.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5899.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8573.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8573.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8573.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8573.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8573.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8573.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8573.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6794.53},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6072.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8573.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections With Cc/Mcc","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9104.01,"maximum":18008.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18008.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12005.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12005.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12617.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9340.93},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9104.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12005.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12005.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10115.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12005.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12005.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12005.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12005.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12005.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12005.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12005.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11650.77},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10412.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12005.61,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8406.04,"10th_percentile":8406.04,"90th_percentile":8406.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures Without Cc/Mcc","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8442.6,"maximum":16939.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16939.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11292.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11292.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11868.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8662.3},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8442.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11292.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11292.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9380.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11292.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11292.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11292.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11292.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11292.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11292.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11292.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10804.34},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9655.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11292.82,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures With Cc/Mcc","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13059.97,"maximum":26802.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26802.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17868.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17868.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18779.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13399.82},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13059.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17868.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17868.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14511.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17868.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17868.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17868.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17868.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17868.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17868.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17868.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16713.36},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14936.41},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17868.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extraocular Procedures Except Orbit","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11982.92,"maximum":23076.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23076.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15384.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15384.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16168.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12294.75},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11982.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15384.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15384.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13314.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15384.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15384.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15384.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15384.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15384.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15384.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15384.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15335.03},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13704.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15384.12,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures Without Cc/Mcc","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9252.73,"maximum":20595.50,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20595.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13730.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13730.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14430.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9493.52},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9252.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13730.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13730.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10280.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13730.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13730.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13730.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13730.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13730.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13730.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13730.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11841.1},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10582.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13730.33,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures With Cc/Mcc","code_information":[{"code":"113","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17663.24,"maximum":34207.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34207.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22804.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22804.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23967.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18122.89},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17663.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22804.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22804.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19625.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22804.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22804.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22804.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22804.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22804.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22804.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22804.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22604.36},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20201.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22804.84,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6654.83,"maximum":13548.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13548.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9032.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9032.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9493.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6828.01},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6654.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9032.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9032.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7394.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9032.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9032.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9032.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9032.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9032.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9032.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9032.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8516.45},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7610.99},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9032.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":819.71,"10th_percentile":819.71,"90th_percentile":819.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6953.04,"10th_percentile":6953.04,"90th_percentile":6953.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":26556.09,"10th_percentile":26556.09,"90th_percentile":26556.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 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":7510.34,"10th_percentile":7510.34,"90th_percentile":7510.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9075.05,"maximum":17430.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17430.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11620.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11620.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12212.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9311.21},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9075.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11620.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11620.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10083.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11620.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11620.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11620.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11620.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11620.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11620.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11620.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11613.71},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10378.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11620.12,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":10175.96,"10th_percentile":10175.96,"90th_percentile":10175.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":30846.45,"10th_percentile":30846.45,"90th_percentile":30846.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7213.7,"maximum":14453.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14453.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9635.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9635.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10126.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7401.42},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7213.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9635.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9635.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8015.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9635.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9635.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9635.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9635.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9635.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9635.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9635.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9231.67},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8250.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9635.38,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":12613.87,"10th_percentile":12613.87,"90th_percentile":12613.87,"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":6751.92,"10th_percentile":4576.65,"90th_percentile":9573.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8551.39,"10th_percentile":8551.39,"90th_percentile":8551.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":18646.14,"10th_percentile":18646.14,"90th_percentile":18646.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5690.74,"10th_percentile":5519.66,"90th_percentile":6971.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":594.37,"10th_percentile":594.37,"90th_percentile":594.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":18975.68,"10th_percentile":18975.68,"90th_percentile":22062.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4829.12,"10th_percentile":4829.12,"90th_percentile":5519.66,"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":"1 through 10","median_amount":8291.95,"10th_percentile":8291.95,"90th_percentile":8291.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8329.39,"10th_percentile":8329.39,"90th_percentile":8329.39,"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":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8019.27,"10th_percentile":8019.27,"90th_percentile":8019.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7383.41,"10th_percentile":7383.41,"90th_percentile":7383.41,"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: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":9232.67,"10th_percentile":9232.67,"90th_percentile":9232.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8162.81,"10th_percentile":8162.81,"90th_percentile":8162.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":53807.82,"10th_percentile":53807.82,"90th_percentile":53807.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16266.92,"10th_percentile":16266.92,"90th_percentile":16428.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15071.75,"10th_percentile":15071.75,"90th_percentile":15071.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":14845.83,"10th_percentile":14845.83,"90th_percentile":14845.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":238.71,"10th_percentile":238.71,"90th_percentile":238.71,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":24284.24,"10th_percentile":24284.24,"90th_percentile":24284.24,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15583.54,"10th_percentile":15583.54,"90th_percentile":15583.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"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":10905.09,"maximum":20723.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20723.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13815.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13815.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14520.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11188.87},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10905.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13815.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13815.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12116.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13815.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13815.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13815.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13815.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13815.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13815.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13815.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13955.68},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12471.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13815.79,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16978.35,"maximum":33440.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33440.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22293.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22293.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23430.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17420.17},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16978.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22293.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22293.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18864.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22293.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22293.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22293.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22293.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22293.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22293.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22293.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21727.87},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19417.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22293.89,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28059.56,"maximum":51400.30,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51400.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34266.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34266.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36014.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28789.74},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28059.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34266.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34266.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31177.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34266.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34266.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34266.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34266.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34266.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34266.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34266.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35908.94},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32091.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34266.87,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":41622.86,"10th_percentile":41622.86,"90th_percentile":41622.86,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":15471.28,"10th_percentile":15471.28,"90th_percentile":15471.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18762.21,"maximum":37318.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37318.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24878.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24878.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26147.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19250.45},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18762.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24878.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24878.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20846.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24878.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24878.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24878.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24878.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24878.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24878.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24878.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24010.75},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21457.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24878.68,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18762.21,"maximum":37318.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37318.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24878.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24878.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26147.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19250.45},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18762.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24878.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24878.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20846.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24878.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24878.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24878.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24878.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24878.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24878.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24878.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24010.75},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21457.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24878.68,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":117549.88,"10th_percentile":117549.88,"90th_percentile":117549.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28557.38,"maximum":50140.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50140.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33426.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33426.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35131.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":29300.52},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28557.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33426.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33426.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31730.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33426.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33426.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33426.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33426.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33426.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33426.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33426.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36546.02},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32660.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33426.79,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":92194.27,"10th_percentile":92194.27,"90th_percentile":92194.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6178.14,"maximum":13003.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13003.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8668.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8668.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9111.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6338.92},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6178.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8668.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8668.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6864.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8668.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8668.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8668.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8668.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8668.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8668.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8668.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7906.42},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7065.81},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8668.92,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":25914.34,"10th_percentile":25914.34,"90th_percentile":25914.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":68100.23,"10th_percentile":68100.23,"90th_percentile":68100.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8189.9,"10th_percentile":8189.9,"90th_percentile":8189.9,"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":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6943.83,"10th_percentile":6943.83,"90th_percentile":6943.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19571.02,"10th_percentile":19571.02,"90th_percentile":19571.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5933.27,"10th_percentile":5933.27,"90th_percentile":5933.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9997.24,"10th_percentile":9997.24,"90th_percentile":9997.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":7906.42,"10th_percentile":7906.42,"90th_percentile":7906.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1458.78,"10th_percentile":1458.78,"90th_percentile":1458.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8287.62,"maximum":16095.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16095.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10730.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10730.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11277.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8503.29},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8287.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10730.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10730.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9208.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10730.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10730.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10730.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10730.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10730.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10730.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10730.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10606.0},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9478.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10730.03,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10692.36,"10th_percentile":10692.36,"90th_percentile":10692.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49144.65,"10th_percentile":49144.65,"90th_percentile":49144.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":83742.27,"10th_percentile":83742.27,"90th_percentile":83742.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12684.75,"10th_percentile":12684.75,"90th_percentile":12684.75,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7028.64,"10th_percentile":6925.71,"90th_percentile":8691.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25237.11,"10th_percentile":25237.11,"90th_percentile":25237.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35226.79,"10th_percentile":35226.79,"90th_percentile":35226.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":62334.42,"10th_percentile":62334.42,"90th_percentile":68205.67,"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":1400.0,"10th_percentile":1400.0,"90th_percentile":1400.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7894.08,"10th_percentile":7894.08,"90th_percentile":7894.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17040.92,"10th_percentile":17040.92,"90th_percentile":17040.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":10220.44,"10th_percentile":10220.44,"90th_percentile":10220.44,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28266.14,"10th_percentile":28266.14,"90th_percentile":28266.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14267.73,"maximum":26094.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26094.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17396.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17396.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18283.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14639.02},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14267.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17396.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17396.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15853.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17396.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17396.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17396.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17396.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17396.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17396.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17396.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18258.99},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16317.71},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17396.14,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6237.18,"10th_percentile":6237.18,"90th_percentile":6237.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35706.75,"10th_percentile":35706.75,"90th_percentile":35706.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":44399.25,"10th_percentile":44399.25,"90th_percentile":44399.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33667.59,"10th_percentile":33667.59,"90th_percentile":33667.59,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":18252.0,"10th_percentile":18252.0,"90th_percentile":18252.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in 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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":20077.2,"10th_percentile":20077.2,"90th_percentile":20077.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34317.87,"10th_percentile":34317.87,"90th_percentile":34317.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10692.36,"10th_percentile":10692.36,"90th_percentile":12474.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30164.03,"10th_percentile":30164.03,"90th_percentile":30164.03,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6709.62,"maximum":13370.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13370.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8913.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8913.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9368.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6884.22},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6709.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8913.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8913.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7455.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8913.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8913.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8913.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8913.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8913.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8913.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8913.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8586.57},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7673.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8913.49,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8391.72,"maximum":17126.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17126.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11417.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11417.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11999.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8610.1},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8391.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11417.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11417.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9324.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11417.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11417.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11417.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11417.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11417.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11417.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11417.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10739.23},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9597.44},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11417.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Mcc","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11041.29,"maximum":20579.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20579.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13719.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13719.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14419.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11328.61},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11041.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13719.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13719.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12268.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13719.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13719.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13719.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13719.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13719.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13719.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13719.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14129.98},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12627.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13719.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":104924.97,"10th_percentile":104924.97,"90th_percentile":104924.97,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6919.4,"maximum":14618.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14618.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9745.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9745.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10242.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7099.46},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6919.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9745.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9745.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7688.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9745.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9745.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9745.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9745.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9745.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9745.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9745.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8855.03},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7913.57},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9745.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13034.54,"10th_percentile":13034.54,"90th_percentile":13034.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":3172.27,"10th_percentile":3172.27,"90th_percentile":3172.27,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10266.38,"maximum":19909.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19909.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13273.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13273.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13949.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10533.54},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10266.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13273.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13273.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11407.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13273.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13273.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13273.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13273.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13273.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13273.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13273.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13138.3},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11741.44},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13273.01,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":7765.42,"10th_percentile":7765.42,"90th_percentile":7765.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23432.82,"10th_percentile":23432.82,"90th_percentile":23432.82,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8354.1,"10th_percentile":8354.1,"90th_percentile":8354.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":723.58,"10th_percentile":723.58,"90th_percentile":723.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17736.04,"maximum":33127.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33127.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22084.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22084.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23211.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18197.58},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17736.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22084.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22084.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19706.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22084.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22084.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22084.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22084.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22084.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22084.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22084.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22697.52},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20284.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22084.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":18614.35,"10th_percentile":18614.35,"90th_percentile":18614.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":31493.99,"10th_percentile":31493.99,"90th_percentile":31493.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16349.51,"10th_percentile":16349.51,"90th_percentile":16349.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7482.97,"maximum":15178.60,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15178.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10119.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10119.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10635.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7677.69},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7482.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10119.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10119.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8314.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10119.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10119.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10119.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10119.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10119.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10119.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10119.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9576.25},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8558.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10119.07,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":12918.21,"10th_percentile":12918.21,"90th_percentile":12918.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":2370.65,"10th_percentile":2370.65,"90th_percentile":2370.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5040.01,"10th_percentile":5040.01,"90th_percentile":5040.01,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8596.76,"10th_percentile":8596.76,"90th_percentile":8596.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7150.08,"10th_percentile":7150.08,"90th_percentile":7150.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10882.39,"maximum":21179.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21179.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14119.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14119.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14839.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11165.58},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10882.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14119.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14119.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12091.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14119.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14119.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14119.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14119.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14119.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14119.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14119.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13926.64},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12445.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14119.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":5041.47,"10th_percentile":5041.47,"90th_percentile":5041.47,"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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":22220.13,"10th_percentile":22220.13,"90th_percentile":22220.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":12032.0,"10th_percentile":12032.0,"90th_percentile":12032.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, 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":12331.64,"10th_percentile":12331.64,"90th_percentile":12331.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":37612.97,"10th_percentile":37612.97,"90th_percentile":37612.97,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6190.06,"10th_percentile":6190.06,"90th_percentile":6763.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11741.19,"10th_percentile":11741.19,"90th_percentile":11741.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10635.97,"10th_percentile":10635.97,"90th_percentile":10635.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18160.28,"maximum":33314.00,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33314.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22209.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22209.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23342.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18632.86},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18160.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22209.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22209.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20178.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22209.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22209.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22209.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22209.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22209.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22209.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22209.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23240.44},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20769.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22209.33,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16728.28,"10th_percentile":16728.28,"90th_percentile":17693.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19035.44,"10th_percentile":19035.44,"90th_percentile":19035.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7082.2,"maximum":14357.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14357.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9571.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9571.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10059.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7266.5},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7082.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9571.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9571.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7869.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9571.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9571.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9571.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9571.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9571.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9571.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9571.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9063.38},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8099.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9571.74,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15559.25,"maximum":26827.90,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26827.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17885.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17885.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18797.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15964.14},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15559.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17885.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17885.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17288.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17885.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17885.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17885.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17885.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17885.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17885.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17885.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19911.79},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17794.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17885.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5218.51,"maximum":6678.33,"payers_information":[{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5354.31},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5218.51},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5798.34},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6678.33},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5968.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7810.15,"maximum":9994.96,"payers_information":[{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8013.39},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7810.15},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8677.95},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9994.96},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8932.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12102.68,"maximum":15488.29,"payers_information":[{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12417.62},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12102.68},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13447.43},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15488.29},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13841.58}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 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":16040.34,"10th_percentile":16040.34,"90th_percentile":16040.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7176.92,"maximum":13397.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13397.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8931.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8931.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9387.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7363.68},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7176.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8931.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8931.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7974.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8931.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8931.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8931.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8931.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8931.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8931.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8931.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9184.59},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8208.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8931.68,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":20175.03,"10th_percentile":20175.03,"90th_percentile":20175.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13481.86,"maximum":28293.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28293.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18862.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18862.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19824.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13832.7},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13481.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18862.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18862.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14979.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18862.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18862.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18862.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18862.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18862.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18862.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18862.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17253.28},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15418.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18862.64,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":19297.67,"10th_percentile":19297.67,"90th_percentile":19297.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23606.02,"10th_percentile":23606.02,"90th_percentile":23606.02,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8159.25,"maximum":16201.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16201.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10800.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10800.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11351.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8371.58},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8159.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10800.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10800.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9065.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10800.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10800.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10800.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10800.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10800.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10800.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10800.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10441.72},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9331.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10800.95,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1048.53,"10th_percentile":1048.53,"90th_percentile":1048.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31451.44,"10th_percentile":31451.44,"90th_percentile":31451.44,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":48207.86,"10th_percentile":48207.86,"90th_percentile":48207.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7881.05,"10th_percentile":5539.6,"90th_percentile":8859.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":677.88,"10th_percentile":677.88,"90th_percentile":677.88,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9110.23,"10th_percentile":9110.23,"90th_percentile":9110.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12097.2,"maximum":24022.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24022.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16015.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16015.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16831.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12412.0},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12097.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16015.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16015.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13441.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16015.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16015.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16015.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16015.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16015.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16015.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16015.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15481.27},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13835.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16015.09,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":13398.58,"10th_percentile":13398.58,"90th_percentile":13398.58,"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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8657.36,"10th_percentile":8657.36,"90th_percentile":8657.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11196.01,"10th_percentile":11196.01,"90th_percentile":11196.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5871.31,"maximum":12456.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12456.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8304.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8304.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8727.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6024.1},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5871.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8304.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8304.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6523.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8304.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8304.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8304.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8304.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8304.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8304.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8304.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7513.75},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6714.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8304.34,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":6715.79,"10th_percentile":6715.79,"90th_percentile":6715.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8248.48,"maximum":16135.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16135.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10757.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10757.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11305.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8463.13},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8248.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10757.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10757.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9164.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10757.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10757.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10757.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10757.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10757.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10757.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10757.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10555.91},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9433.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10757.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":7866.69,"10th_percentile":7866.69,"90th_percentile":7866.69,"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":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":80933.74,"10th_percentile":80933.74,"90th_percentile":80933.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11863.8,"10th_percentile":11863.8,"90th_percentile":11863.8,"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":"1 through 10","median_amount":9105.68,"10th_percentile":9105.68,"90th_percentile":9105.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":389.06,"10th_percentile":389.06,"90th_percentile":389.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5600.7,"10th_percentile":5600.7,"90th_percentile":5600.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13609.45,"maximum":24847.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24847.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16565.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16565.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17409.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13963.6},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13609.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16565.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16565.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15121.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16565.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16565.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16565.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16565.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16565.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16565.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16565.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17416.56},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15564.84},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16565.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":14801.68,"10th_percentile":14801.68,"90th_percentile":14801.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8575.11,"10th_percentile":8575.11,"90th_percentile":8575.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16164.26,"10th_percentile":16164.26,"90th_percentile":16164.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14400.31,"10th_percentile":14400.31,"90th_percentile":14400.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14489.6,"10th_percentile":14489.6,"90th_percentile":14489.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6263.46,"maximum":13037.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13037.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8691.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8691.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9134.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6426.45},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6263.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8691.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8691.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6959.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8691.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8691.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8691.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8691.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8691.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8691.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8691.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8015.6},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7163.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8691.65,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6859.65,"10th_percentile":6859.65,"90th_percentile":6859.65,"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] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8450.65,"10th_percentile":8450.65,"90th_percentile":8450.65,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7139.77,"10th_percentile":7139.77,"90th_percentile":7139.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6900.61,"maximum":13932.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13932.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9288.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9288.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9761.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7080.18},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6900.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9288.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9288.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7667.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9288.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9288.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9288.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9288.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9288.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9288.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9288.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8830.99},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7892.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9288.08,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":40212.61,"10th_percentile":40212.61,"90th_percentile":40212.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7860.45,"10th_percentile":7860.45,"90th_percentile":7860.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11395.09,"maximum":22173.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22173.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14782.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14782.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15536.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11691.62},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11395.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14782.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14782.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12661.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14782.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14782.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14782.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14782.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14782.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14782.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14782.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14582.75},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13032.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14782.25,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10491.49,"10th_percentile":10491.49,"90th_percentile":10491.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5387.58,"maximum":11477.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11477.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7651.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7651.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8041.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5527.78},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5387.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7651.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7651.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5986.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7651.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7651.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7651.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7651.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7651.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7651.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7651.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6894.7},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6161.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7651.55,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":100520.47,"10th_percentile":100520.47,"90th_percentile":100520.47,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":46421.67,"10th_percentile":46421.67,"90th_percentile":46421.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4658.43,"10th_percentile":4658.43,"90th_percentile":4658.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6071.18,"10th_percentile":6071.18,"90th_percentile":6071.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6579.79,"10th_percentile":6579.79,"90th_percentile":6579.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6174.19,"10th_percentile":6174.19,"90th_percentile":6367.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"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":7960.44,"maximum":15921.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15921.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10614.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10614.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11155.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8167.59},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7960.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10614.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10614.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8844.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10614.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10614.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10614.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10614.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10614.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10614.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10614.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10187.29},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9104.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10614.57,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":12938.07,"10th_percentile":12938.07,"90th_percentile":12938.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12349.33,"10th_percentile":12349.33,"90th_percentile":12349.33,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8513.29,"10th_percentile":6050.55,"90th_percentile":45316.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34413.27,"10th_percentile":34413.27,"90th_percentile":46640.74,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8450.65,"10th_percentile":8450.65,"90th_percentile":10057.37,"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":"1 through 10","median_amount":8810.39,"10th_percentile":8810.39,"90th_percentile":9308.69,"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":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":39143.5,"10th_percentile":39143.5,"90th_percentile":43306.91,"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":"1 through 10","median_amount":7916.32,"10th_percentile":7916.32,"90th_percentile":8226.05,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10952.57,"10th_percentile":10952.57,"90th_percentile":10952.57,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7843.62,"10th_percentile":6697.64,"90th_percentile":18711.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8927.75,"10th_percentile":7574.45,"90th_percentile":26421.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8872.97,"10th_percentile":8872.97,"90th_percentile":8872.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9329.46,"10th_percentile":9329.46,"90th_percentile":10169.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8157.47,"10th_percentile":8157.47,"90th_percentile":8157.47,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":8149.03,"10th_percentile":8149.03,"90th_percentile":8149.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":7376.12,"10th_percentile":7051.95,"90th_percentile":9907.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15569.42,"maximum":29569.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29569.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19712.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19712.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20718.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15974.58},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15569.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19712.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19712.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17299.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19712.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19712.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19712.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19712.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19712.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19712.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19712.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19924.81},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17806.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19712.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":15374.14,"10th_percentile":15374.14,"90th_percentile":18098.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16284.09,"10th_percentile":16284.09,"90th_percentile":16284.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":35728.15,"10th_percentile":35728.15,"90th_percentile":35728.15,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":108374.12,"10th_percentile":108374.12,"90th_percentile":108374.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":15541.55,"10th_percentile":15541.55,"90th_percentile":15541.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16768.42,"10th_percentile":16768.42,"90th_percentile":16768.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16265.37,"10th_percentile":16265.37,"90th_percentile":16265.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":118156.4,"10th_percentile":68686.54,"90th_percentile":153492.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12373.76,"10th_percentile":8182.84,"90th_percentile":18113.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16426.79,"10th_percentile":14950.77,"90th_percentile":32072.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":13305.55,"10th_percentile":13305.55,"90th_percentile":13305.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":28147.66,"10th_percentile":28147.66,"90th_percentile":28147.66,"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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14620.24,"10th_percentile":14061.66,"90th_percentile":18427.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10995.11,"maximum":21288.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21288.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14192.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14192.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14915.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11281.23},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10995.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14192.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14192.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12216.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14192.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14192.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14192.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14192.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14192.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14192.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14192.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14070.88},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12574.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14192.19,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13938.98,"maximum":26107.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26107.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17405.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17405.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18292.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14301.71},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13938.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17405.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17405.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15487.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17405.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17405.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17405.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17405.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17405.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17405.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17405.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17838.27},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15941.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17405.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":71683.83,"10th_percentile":71683.83,"90th_percentile":71683.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8450.65,"10th_percentile":8450.65,"90th_percentile":8450.65,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16535.96,"10th_percentile":16535.96,"90th_percentile":16535.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21158.95,"maximum":39744.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39744.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26496.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26496.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27847.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21709.56},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21158.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26496.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26496.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23509.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26496.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26496.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26496.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26496.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26496.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26496.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26496.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27077.95},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24199.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26496.11,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":21631.49,"10th_percentile":21631.49,"90th_percentile":21631.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8989.6,"10th_percentile":8989.6,"90th_percentile":8989.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6985.14,"maximum":14687.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14687.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9791.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9791.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10291.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7166.92},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6985.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9791.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9791.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7761.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9791.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9791.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9791.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9791.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9791.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9791.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9791.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8939.17},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7988.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9791.76,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6803.08,"10th_percentile":6803.08,"90th_percentile":6803.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9576.79,"maximum":19066.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19066.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12711.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12711.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13359.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9826.0},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9576.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12711.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12711.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10640.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12711.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12711.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12711.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12711.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12711.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12711.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12711.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12255.8},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10952.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12711.14,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14446.98,"maximum":25457.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25457.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16971.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16971.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17837.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14822.93},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14446.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16971.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16971.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16052.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16971.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16971.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16971.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16971.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16971.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16971.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16971.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18488.38},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16522.71},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16971.55,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10447.19,"maximum":19812.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19812.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13208.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13208.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13882.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10719.06},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10447.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13208.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13208.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11607.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13208.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13208.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13208.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13208.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13208.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13208.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13208.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13369.69},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11948.23},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13208.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":17393.84,"10th_percentile":17393.84,"90th_percentile":17393.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6237.18,"10th_percentile":6237.18,"90th_percentile":6237.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22441.39,"10th_percentile":16171.2,"90th_percentile":30431.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46312.32,"10th_percentile":46312.32,"90th_percentile":84672.04,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":24753.28,"10th_percentile":24753.28,"90th_percentile":24753.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11248.01,"10th_percentile":11248.01,"90th_percentile":11248.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":64446.63,"10th_percentile":26780.04,"90th_percentile":74731.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24375.06,"10th_percentile":24375.06,"90th_percentile":45705.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":17820.6,"10th_percentile":8768.67,"90th_percentile":23166.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14833.5,"10th_percentile":10040.52,"90th_percentile":38715.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9640.44,"10th_percentile":9640.44,"90th_percentile":9640.44,"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":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":15514.2,"10th_percentile":14344.4,"90th_percentile":39213.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41087.75,"10th_percentile":41087.75,"90th_percentile":41087.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":14541.44,"10th_percentile":14541.44,"90th_percentile":14541.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":47019.0,"10th_percentile":47019.0,"90th_percentile":47019.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, 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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29008.87,"10th_percentile":22563.9,"90th_percentile":37773.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19599.73,"maximum":33825.40,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33825.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22550.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22550.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23700.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20109.77},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19599.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22550.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22550.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21777.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22550.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22550.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22550.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22550.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22550.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22550.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22550.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25082.57},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22415.81},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22550.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6237.21,"10th_percentile":6237.21,"90th_percentile":6237.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16501.22,"10th_percentile":16501.22,"90th_percentile":16501.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21269.22,"10th_percentile":21269.22,"90th_percentile":21269.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":94469.29,"10th_percentile":94469.29,"90th_percentile":94469.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37486.9,"10th_percentile":37486.9,"90th_percentile":37486.9,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":29756.57,"10th_percentile":29756.57,"90th_percentile":29756.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20228.43,"10th_percentile":20228.43,"90th_percentile":20228.43,"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":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":43258.21,"10th_percentile":43258.21,"90th_percentile":43258.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11583.39,"10th_percentile":11583.39,"90th_percentile":11583.39,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15699.84,"10th_percentile":12012.61,"90th_percentile":25708.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25747.06,"10th_percentile":25747.06,"90th_percentile":25747.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":44563.08,"10th_percentile":44563.08,"90th_percentile":44563.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":28014.0,"10th_percentile":28014.0,"90th_percentile":28014.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, 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":23212.79,"10th_percentile":23212.79,"90th_percentile":38214.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8538.88,"maximum":16048.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16048.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10699.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10699.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11244.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8761.08},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8538.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10699.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10699.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9487.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10699.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10699.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10699.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10699.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10699.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10699.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10699.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10927.55},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9765.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10699.12,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5473.49,"10th_percentile":5473.49,"90th_percentile":5473.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9214.02,"10th_percentile":9214.02,"90th_percentile":9214.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11734.01,"maximum":22967.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22967.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15311.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15311.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16092.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12039.36},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11734.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15311.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15311.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13037.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15311.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15311.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15311.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15311.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15311.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15311.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15311.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15016.48},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13419.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15311.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":21881.53,"10th_percentile":21881.53,"90th_percentile":21881.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":6754.09,"10th_percentile":6754.09,"90th_percentile":6754.09,"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":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7049.01,"10th_percentile":7049.01,"90th_percentile":7049.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13497.41,"10th_percentile":13497.41,"90th_percentile":13497.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7211.36,"maximum":15497.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15497.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10331.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10331.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10858.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7399.02},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7211.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10331.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10331.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8012.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10331.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10331.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10331.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10331.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10331.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10331.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10331.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9228.66},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8247.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10331.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15751.8,"maximum":26845.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26845.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17897.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17897.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18809.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16161.71},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15751.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17897.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17897.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17502.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17897.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17897.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17897.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17897.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17897.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17897.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17897.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20158.21},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18015.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17897.09,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10822.97,"10th_percentile":10822.97,"90th_percentile":10822.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11583.39,"10th_percentile":11583.39,"90th_percentile":11583.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":65382.05,"10th_percentile":65382.05,"90th_percentile":65382.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":19602.66,"10th_percentile":19602.66,"90th_percentile":19602.66,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":15673.0,"10th_percentile":15673.0,"90th_percentile":15673.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, 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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13756.6,"maximum":25705.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25705.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17137.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17137.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18011.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14114.59},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13756.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17137.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17137.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15285.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17137.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17137.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17137.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17137.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17137.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17137.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17137.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17604.88},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15733.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17137.02,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":489.13,"10th_percentile":489.13,"90th_percentile":489.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17678.9,"maximum":32128.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32128.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21419.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21419.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22511.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18138.95},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17678.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21419.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21419.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19643.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21419.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21419.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21419.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21419.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21419.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21419.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21419.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22624.4},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20218.99},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21419.25,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":18329.3,"10th_percentile":18329.3,"90th_percentile":18329.3,"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":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29523.27,"maximum":54801.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54801.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36534.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36534.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38397.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30291.55},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29523.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36534.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36534.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32803.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36534.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36534.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36534.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36534.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36534.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36534.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36534.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37782.12},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33765.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36534.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8909.11,"maximum":18174.80,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18174.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12116.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12116.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12734.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9140.95},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8909.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12116.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12116.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9899.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12116.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12116.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12116.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12116.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12116.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12116.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12116.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11401.35},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10189.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12116.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":14562.32,"10th_percentile":14562.32,"90th_percentile":14562.32,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Cc","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12610.68,"maximum":24272.20,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24272.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16181.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16181.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17006.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12938.84},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12610.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16181.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16181.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14011.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16181.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16181.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16181.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16181.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16181.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16181.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16181.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16138.39},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14422.57},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16181.47,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25992.35,"maximum":47040.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47040.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31360.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31360.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32959.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26668.74},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25992.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31360.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31360.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28880.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31360.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31360.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31360.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31360.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31360.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31360.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31360.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33263.45},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29726.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31360.22,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures Without Cc/Mcc","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14347.57,"maximum":28638.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28638.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19092.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19092.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20066.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14720.93},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14347.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19092.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19092.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15941.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19092.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19092.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19092.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19092.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19092.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19092.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19092.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18361.16},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16409.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19092.66,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Cc","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17804.14,"maximum":34744.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34744.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23163.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23163.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24344.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18267.45},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17804.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23163.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23163.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19782.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23163.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23163.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23163.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23163.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23163.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23163.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23163.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22784.67},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20362.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23163.06,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Mcc","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30436.73,"maximum":54931.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54931.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36620.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36620.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38488.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31228.78},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30436.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36620.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36620.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33818.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36620.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36620.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36620.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36620.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36620.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36620.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36620.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38951.1},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34809.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36620.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures Without Cc/Mcc","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12487.79,"maximum":24821.80,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24821.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16547.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16547.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17391.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12812.75},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12487.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16547.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16547.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13875.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16547.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16547.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16547.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16547.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16547.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16547.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16547.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15981.12},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14282.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16547.87,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Cc","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16715.35,"maximum":31205.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31205.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20803.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20803.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21864.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17150.33},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16715.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20803.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20803.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18572.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20803.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20803.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20803.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20803.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20803.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20803.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20803.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21391.3},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19117.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20803.74,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17030.49,"10th_percentile":17030.49,"90th_percentile":17030.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32799.03,"maximum":63247.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63247.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42164.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42164.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44315.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":33652.55},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32799.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42164.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42164.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36443.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42164.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42164.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42164.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42164.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42164.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42164.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42164.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41974.24},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37511.57},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42164.91,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures Without Cc/Mcc","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17417.46,"maximum":32081.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32081.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21387.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21387.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22478.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17870.71},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17417.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21387.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21387.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19352.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21387.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21387.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21387.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21387.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21387.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21387.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21387.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22289.83},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19919.99},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21387.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":56123.81,"10th_percentile":56123.81,"90th_percentile":56123.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26272.57,"maximum":48670.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48670.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32446.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32446.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34101.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26956.25},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26272.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32446.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32446.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29191.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32446.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32446.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32446.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32446.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32446.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32446.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32446.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33622.06},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30047.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32446.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":34239.3,"10th_percentile":34239.3,"90th_percentile":34239.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":27518.63,"10th_percentile":27518.63,"90th_percentile":27518.63,"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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":83884.47,"10th_percentile":83884.47,"90th_percentile":83884.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":82928.28,"10th_percentile":82928.28,"90th_percentile":82928.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":73517.48,"10th_percentile":73517.48,"90th_percentile":73517.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28428.94,"10th_percentile":28428.94,"90th_percentile":28428.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47583.36,"maximum":84083.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84083.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56055.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56055.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58914.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":48821.62},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47583.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56055.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56055.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52870.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56055.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56055.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56055.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56055.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56055.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56055.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56055.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60894.34},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54420.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56055.35,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":25036.86,"10th_percentile":25036.86,"90th_percentile":25036.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":79311.82,"10th_percentile":79311.82,"90th_percentile":79311.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39872.62,"10th_percentile":39872.62,"90th_percentile":39872.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19314.82,"maximum":36550.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36550.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24366.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24366.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25609.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19817.44},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19314.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24366.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24366.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21460.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24366.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24366.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24366.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24366.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24366.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24366.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24366.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24717.95},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22089.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24366.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":19025.4,"10th_percentile":19025.4,"90th_percentile":19025.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":78534.26,"10th_percentile":78534.26,"90th_percentile":78534.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":14743.2,"10th_percentile":14743.2,"90th_percentile":14743.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23939.23,"maximum":44546.00,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44546.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29697.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29697.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31211.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24562.19},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23939.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29697.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29697.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26599.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29697.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29697.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29697.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29697.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29697.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29697.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29697.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30635.99},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27378.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29697.33,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Mcc","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35004.0,"maximum":64150.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64150.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42766.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42766.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44947.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":35914.9},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35004.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42766.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42766.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38893.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42766.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42766.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42766.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42766.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42766.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42766.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42766.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44796.02},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40033.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42766.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24523.78,"10th_percentile":24523.78,"90th_percentile":24523.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","code_information":[{"code":"024","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29754.96,"maximum":55492.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55492.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36995.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36995.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38882.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30529.27},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29754.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36995.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36995.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33061.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36995.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36995.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36995.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36995.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36995.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36995.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36995.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38078.62},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34030.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36995.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44652.8,"maximum":80291.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80291.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53527.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53527.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56257.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":45814.79},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44652.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53527.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53527.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49614.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53527.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53527.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53527.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53527.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53527.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53527.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53527.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57143.98},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51068.47},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53527.83,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":35772.63,"10th_percentile":35772.63,"90th_percentile":35772.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27633.75,"maximum":45476.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45476.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30317.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30317.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31863.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28352.85},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27633.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30317.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30317.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30704.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30317.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30317.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30317.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30317.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30317.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30317.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30317.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35364.02},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31604.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30317.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43264.22,"maximum":74338.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74338.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49559.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49559.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52086.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":44390.08},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43264.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49559.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49559.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48071.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49559.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49559.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49559.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49559.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49559.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49559.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49559.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55366.96},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49480.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49559.26,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":63092.52,"maximum":109455.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":109455.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72970.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72970.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":76692.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":64734.36},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63092.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72970.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72970.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":70102.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72970.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72970.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72970.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72970.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72970.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72970.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72970.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80742.03},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72157.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72970.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":62045.21,"maximum":99443.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99443.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66295.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66295.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":69676.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":63659.8},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62045.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66295.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66295.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":68939.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66295.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66295.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66295.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66295.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66295.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66295.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66295.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79401.75},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70959.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66295.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant Without Cc/Mcc","code_information":[{"code":"017","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47242.09,"maximum":76227.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76227.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50818.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50818.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53410.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":48471.46},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47242.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50818.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50818.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52491.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50818.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50818.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50818.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50818.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50818.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50818.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50818.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60457.6},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54029.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50818.48,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant With Cc/Mcc","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47242.09,"maximum":83011.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83011.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55340.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55340.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58163.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":48471.46},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47242.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55340.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55340.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52491.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55340.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55340.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55340.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55340.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55340.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55340.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55340.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60457.6},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54029.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55340.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allogeneic Bone Marrow Transplant","code_information":[{"code":"014","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":102545.59,"maximum":166040.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":166040.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110693.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110693.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":116338.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":105214.11},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":102545.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110693.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110693.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":113939.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110693.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110693.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110693.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110693.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110693.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110693.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110693.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":131231.72},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":117279.26},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":110693.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32118.83,"maximum":59640.20,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59640.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39760.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39760.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41787.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":32954.65},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32118.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39760.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39760.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35687.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39760.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39760.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39760.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39760.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39760.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39760.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39760.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41103.76},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36733.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39760.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Cc","code_information":[{"code":"412","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16684.04,"maximum":30816.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30816.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20544.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20544.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21592.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17118.2},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16684.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20544.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20544.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18537.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20544.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20544.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20544.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20544.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20544.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20544.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20544.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21351.24},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19081.19},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20544.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. Without Cc/Mcc","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13012.22,"maximum":24789.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24789.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16526.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16526.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17368.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13350.83},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13012.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16526.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16526.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14458.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16526.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16526.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16526.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16526.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16526.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16526.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16526.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16652.26},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14881.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16526.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27423.97,"maximum":50729.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50729.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33819.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33819.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35544.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28137.62},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27423.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33819.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33819.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30471.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33819.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33819.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33819.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33819.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33819.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33819.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33819.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35095.56},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31364.23},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33819.55,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19177.76,"10th_percentile":19177.76,"90th_percentile":19177.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15482.54,"maximum":30328.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30328.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20219.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20219.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21250.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15885.44},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15482.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20219.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20219.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17202.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20219.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20219.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20219.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20219.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20219.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20219.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20219.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19813.63},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17707.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20219.14,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10725.06,"maximum":20735.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20735.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13823.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13823.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14528.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11004.16},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10725.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13823.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13823.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11916.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13823.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13823.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13823.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13823.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13823.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13823.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13823.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13725.29},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12266.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13823.97,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18601.74,"maximum":34688.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34688.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23125.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23125.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24305.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19085.81},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18601.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23125.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23125.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20668.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23125.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23125.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23125.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23125.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23125.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23125.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23125.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23805.4},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21274.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23125.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11740.43,"10th_percentile":11740.43,"90th_percentile":12061.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":76790.55,"10th_percentile":61553.54,"90th_percentile":111283.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":23265.21,"10th_percentile":23265.21,"90th_percentile":23265.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12292.0,"10th_percentile":12292.0,"90th_percentile":12292.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, 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":18276.11,"10th_percentile":18276.11,"90th_percentile":18276.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19296.0,"10th_percentile":19296.0,"90th_percentile":19296.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":23805.4,"10th_percentile":23805.4,"90th_percentile":23805.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":58765.84,"10th_percentile":58765.84,"90th_percentile":58765.84,"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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":56298.79,"10th_percentile":50437.42,"90th_percentile":69287.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11508.03,"10th_percentile":11508.03,"90th_percentile":11508.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9762.99,"10th_percentile":9762.99,"90th_percentile":9762.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10729.48,"10th_percentile":10729.48,"90th_percentile":10729.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11135.18,"10th_percentile":11135.18,"90th_percentile":11135.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12901.62,"10th_percentile":12901.62,"90th_percentile":12901.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11233.68,"10th_percentile":11233.68,"90th_percentile":11233.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Mcc","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27624.35,"maximum":48608.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48608.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32405.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32405.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34058.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28343.22},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27624.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32405.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32405.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30693.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32405.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32405.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32405.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32405.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32405.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32405.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32405.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35352.0},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31593.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32405.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Cc","code_information":[{"code":"421","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12817.32,"maximum":25839.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25839.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17226.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17226.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18104.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13150.86},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12817.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17226.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17226.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14241.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17226.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17226.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17226.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17226.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17226.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17226.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17226.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16402.84},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14658.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17226.12,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11500.75,"maximum":21229.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21229.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14153.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14153.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14874.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11800.04},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11500.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14153.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14153.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12778.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14153.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14153.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14153.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14153.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14153.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14153.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14153.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14717.98},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13153.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14153.09,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","code_information":[{"code":"423","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31834.7,"maximum":58781.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58781.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39187.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39187.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41185.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":32663.12},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31834.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39187.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39187.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35371.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39187.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39187.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39187.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39187.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39187.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39187.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39187.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40740.14},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36408.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39187.35,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30920.5,"10th_percentile":30920.5,"90th_percentile":30920.5,"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] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","code_information":[{"code":"424","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17870.67,"maximum":31981.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31981.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21321.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21321.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22408.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18335.71},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17870.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21321.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21321.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19856.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21321.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21321.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21321.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21321.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21321.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21321.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21321.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22869.81},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20438.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21321.06,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","code_information":[{"code":"425","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12098.77,"maximum":22604.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22604.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15069.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15069.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15838.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12413.61},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12098.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15069.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15069.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13443.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15069.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15069.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15069.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15069.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15069.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15069.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15069.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15483.28},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13837.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15069.55,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","code_information":[{"code":"426","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":82043.36,"maximum":152447.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":152447.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101631.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101631.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":106814.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":84178.36},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82043.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101631.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101631.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":91159.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101631.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101631.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101631.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101631.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101631.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101631.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101631.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":104994.19},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":93831.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":101631.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":366806.3,"10th_percentile":366806.3,"90th_percentile":366806.3,"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":"0","additional_payer_notes":"No services performed during 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":87686.98,"10th_percentile":87686.98,"90th_percentile":87686.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","code_information":[{"code":"427","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55564.15,"maximum":100588.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100588.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67059.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67059.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70479.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":57010.09},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55564.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67059.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67059.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":61737.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67059.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67059.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67059.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67059.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67059.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67059.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67059.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71107.68},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":63547.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67059.14,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":56225.12,"10th_percentile":56225.12,"90th_percentile":56225.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":125254.13,"10th_percentile":125254.13,"90th_percentile":125254.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":33667.09,"10th_percentile":33667.09,"90th_percentile":33667.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":143084.18,"10th_percentile":143084.18,"90th_percentile":407551.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":27189.63,"10th_percentile":27189.63,"90th_percentile":27189.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":44128.82,"10th_percentile":44128.82,"90th_percentile":45317.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":56767.09,"10th_percentile":56767.09,"90th_percentile":56767.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","code_information":[{"code":"428","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43091.24,"maximum":78814.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78814.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52543.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52543.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55222.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":44212.59},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43091.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52543.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52543.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47879.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52543.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52543.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52543.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52543.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52543.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52543.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52543.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55145.59},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49282.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52543.19,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":162535.22,"10th_percentile":162535.22,"90th_percentile":162535.22,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":56629.86,"10th_percentile":56629.86,"90th_percentile":56629.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":139881.61,"10th_percentile":139881.61,"90th_percentile":227537.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45591.08,"10th_percentile":45591.08,"90th_percentile":45591.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43376.56,"10th_percentile":43376.56,"90th_percentile":43376.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":19912.52,"10th_percentile":19912.52,"90th_percentile":19912.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41856.57,"10th_percentile":41856.57,"90th_percentile":41856.57,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":65280.27,"maximum":125013.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":125013.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83342.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83342.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":87593.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":66979.04},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65280.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83342.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83342.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":72533.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83342.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83342.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83342.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83342.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83342.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83342.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83342.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83541.78},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74659.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83342.55,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":18215.94,"10th_percentile":18215.94,"90th_percentile":18215.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15334.6,"maximum":28985.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28985.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19323.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19323.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20309.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15733.65},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15334.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19323.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19323.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17038.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19323.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19323.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19323.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19323.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19323.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19323.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19323.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19624.3},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17537.86},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19323.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":24795.53,"10th_percentile":24795.53,"90th_percentile":24795.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9830.94,"10th_percentile":9830.94,"90th_percentile":9830.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":39582.03,"10th_percentile":39582.03,"90th_percentile":39582.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53984.25,"10th_percentile":53984.25,"90th_percentile":53984.25,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8527.54,"10th_percentile":7847.37,"90th_percentile":19955.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":37795.56,"10th_percentile":29604.12,"90th_percentile":44087.29,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18464.47,"10th_percentile":18464.47,"90th_percentile":18464.47,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9830.94,"10th_percentile":8684.96,"90th_percentile":13268.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16199.74,"10th_percentile":16199.74,"90th_percentile":16199.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11678.42,"10th_percentile":11678.42,"90th_percentile":11678.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":19469.75,"10th_percentile":19469.75,"90th_percentile":19469.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16993.6,"10th_percentile":16993.6,"90th_percentile":16993.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8372.94,"maximum":16547.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16547.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11031.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11031.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11594.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8590.82},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8372.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11031.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11031.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9303.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11031.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11031.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11031.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11031.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11031.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11031.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11031.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10715.18},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9575.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11031.88,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9834.68,"10th_percentile":9834.68,"90th_percentile":9834.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26146.19,"10th_percentile":26146.19,"90th_percentile":26146.19,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":15293.67,"10th_percentile":15293.67,"90th_percentile":15293.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":50468.77,"10th_percentile":50468.77,"90th_percentile":50468.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7338.42,"10th_percentile":7338.42,"90th_percentile":7338.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1084.03,"10th_percentile":1084.03,"90th_percentile":1084.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5450.98,"maximum":11860.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11860.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7907.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7907.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8310.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5592.83},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5450.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7907.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7907.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6056.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7907.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7907.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7907.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7907.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7907.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7907.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7907.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6975.84},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6234.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7907.03,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5798.82,"10th_percentile":5798.82,"90th_percentile":5798.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14281.04,"maximum":27192.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27192.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18128.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18128.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19052.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14652.67},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14281.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18128.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18128.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15867.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18128.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18128.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18128.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18128.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18128.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18128.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18128.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18276.02},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16332.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18128.03,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":15789.03,"10th_percentile":15789.03,"90th_percentile":15789.03,"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":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 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":15166.29,"10th_percentile":15166.29,"90th_percentile":15166.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":48111.17,"10th_percentile":48111.17,"90th_percentile":48111.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15024.52,"10th_percentile":15024.52,"90th_percentile":15024.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8826.14,"maximum":17569.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17569.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11712.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11712.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12310.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9055.82},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8826.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11712.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11712.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9806.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11712.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11712.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11712.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11712.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11712.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11712.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11712.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11295.17},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10094.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11712.86,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8119.17,"10th_percentile":8119.17,"90th_percentile":8119.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10276.03,"10th_percentile":10276.03,"90th_percentile":10276.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10361.68,"10th_percentile":10361.68,"90th_percentile":10361.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6145.27,"maximum":13780.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13780.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9187.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9187.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9655.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6305.19},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6145.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9187.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9187.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6828.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9187.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9187.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9187.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9187.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9187.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9187.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9187.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7864.35},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7028.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9187.16,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13023.18,"maximum":24375.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24375.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16250.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16250.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17079.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13362.08},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13023.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16250.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16250.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14470.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16250.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16250.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16250.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16250.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16250.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16250.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16250.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16666.28},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14894.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16250.57,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8357.03,"10th_percentile":8357.03,"90th_percentile":10092.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":121771.52,"10th_percentile":121771.52,"90th_percentile":121771.52,"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":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34101.15,"10th_percentile":34101.15,"90th_percentile":34101.15,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":21701.7,"10th_percentile":21701.7,"90th_percentile":21701.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9438.3,"10th_percentile":9438.3,"90th_percentile":9438.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9519.96,"10th_percentile":9519.96,"90th_percentile":9519.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8541.46,"10th_percentile":8541.46,"90th_percentile":8541.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12976.09,"10th_percentile":12976.09,"90th_percentile":12976.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6556.48,"10th_percentile":5410.5,"90th_percentile":9154.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7982.66,"10th_percentile":7982.66,"90th_percentile":7982.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":22278.28,"10th_percentile":20840.19,"90th_percentile":54349.25,"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":6686.89,"10th_percentile":6686.89,"90th_percentile":6686.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6932.91,"10th_percentile":6932.91,"90th_percentile":6932.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":11932.85,"10th_percentile":11932.85,"90th_percentile":11932.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":7700.51,"10th_percentile":7700.51,"90th_percentile":7700.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6242.16,"10th_percentile":6242.16,"90th_percentile":6242.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36194.79,"10th_percentile":36194.79,"90th_percentile":36194.79,"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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5983.49,"10th_percentile":5983.49,"90th_percentile":5983.49,"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":"1 through 10","median_amount":1161.86,"10th_percentile":1161.86,"90th_percentile":1161.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6339.39,"10th_percentile":6339.39,"90th_percentile":6339.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":9330.78,"10th_percentile":9330.78,"90th_percentile":9330.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":90038.54,"10th_percentile":90038.54,"90th_percentile":90038.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12543.29,"10th_percentile":12543.29,"90th_percentile":12543.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13729.43,"10th_percentile":8116.02,"90th_percentile":14946.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7562.8,"maximum":15308.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15308.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10725.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7759.61},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7562.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8403.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9678.43},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8649.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.44,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":10514.98,"10th_percentile":10514.98,"90th_percentile":10514.98,"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":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5842.55,"10th_percentile":5842.55,"90th_percentile":5842.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7519.41,"10th_percentile":7519.41,"90th_percentile":7519.41,"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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6016.74,"10th_percentile":6016.74,"90th_percentile":6016.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7835.16,"10th_percentile":7835.16,"90th_percentile":9048.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"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":5499.51,"maximum":11685.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11685.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7790.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7790.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8187.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5642.62},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5499.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7790.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7790.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6110.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7790.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7790.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7790.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7790.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7790.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7790.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7790.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7037.94},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6289.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7790.66,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":39827.04,"10th_percentile":39827.04,"90th_percentile":39827.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3885.19,"10th_percentile":3885.19,"90th_percentile":3885.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5206.26,"10th_percentile":5206.26,"90th_percentile":5206.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13185.2,"maximum":24930.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24930.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16620.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16620.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17468.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13528.32},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13185.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16620.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16620.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14650.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16620.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16620.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16620.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16620.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16620.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16620.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16620.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16873.64},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15079.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16620.61,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":18710.35,"10th_percentile":18710.35,"90th_percentile":18710.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23687.77,"10th_percentile":23687.77,"90th_percentile":23687.77,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6583.13,"10th_percentile":6583.13,"90th_percentile":6583.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8488.0,"maximum":17068.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17068.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11379.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11379.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11959.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8708.88},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8488.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11379.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11379.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9431.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11379.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11379.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11379.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11379.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11379.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11379.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11379.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10862.43},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9707.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11379.19,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7269.07,"10th_percentile":7269.07,"90th_percentile":7549.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":20336.37,"10th_percentile":20336.37,"90th_percentile":20336.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9150.21,"10th_percentile":9150.21,"90th_percentile":9150.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6239.98,"maximum":13426.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13426.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8950.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8950.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9407.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6402.36},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6239.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8950.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8950.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6933.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8950.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8950.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8950.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8950.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8950.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8950.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8950.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7985.55},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7136.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8950.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5606.98,"10th_percentile":5606.98,"90th_percentile":5606.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16797.85,"10th_percentile":16797.85,"90th_percentile":16797.85,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7455.13,"10th_percentile":7455.13,"90th_percentile":7455.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":17471.01,"10th_percentile":17471.01,"90th_percentile":27527.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":7986.55,"10th_percentile":7986.55,"90th_percentile":7986.55,"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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6635.71,"10th_percentile":6635.71,"90th_percentile":6635.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":54101.7,"10th_percentile":54101.7,"90th_percentile":54101.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":262149.7,"10th_percentile":262149.7,"90th_percentile":262149.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":134415.52,"10th_percentile":134415.52,"90th_percentile":134415.52,"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":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":19923.94,"10th_percentile":19350.95,"90th_percentile":32334.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33334.04,"10th_percentile":33334.04,"90th_percentile":33334.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":184305.45,"10th_percentile":181241.32,"90th_percentile":328388.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":24495.11,"10th_percentile":24495.11,"90th_percentile":25964.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31361.01,"10th_percentile":31102.11,"90th_percentile":34952.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":29703.53,"10th_percentile":29703.53,"90th_percentile":29703.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":20322.42,"10th_percentile":20322.42,"90th_percentile":20322.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33175.47,"10th_percentile":33175.47,"90th_percentile":33175.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"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":40308.61,"maximum":74827.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74827.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49884.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49884.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52428.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":41357.55},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40308.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49884.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49884.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44787.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49884.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49884.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49884.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49884.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49884.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49884.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49884.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51584.54},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46100.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49884.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":140905.02,"10th_percentile":140905.02,"90th_percentile":140905.02,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43624.3,"10th_percentile":43624.3,"90th_percentile":43624.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24153.7,"maximum":46198.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46198.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30799.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30799.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32370.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24782.24},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24153.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30799.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30799.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26837.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30799.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30799.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30799.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30799.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30799.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30799.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30799.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30910.46},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27624.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30799.26,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":27012.87,"10th_percentile":27012.87,"90th_percentile":27012.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":149072.15,"10th_percentile":149072.15,"90th_percentile":149072.15,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":26265.59,"10th_percentile":26265.59,"90th_percentile":26265.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":100652.26,"10th_percentile":78356.16,"90th_percentile":149313.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":21963.92,"10th_percentile":21963.92,"90th_percentile":24208.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24770.93,"10th_percentile":24770.93,"90th_percentile":24770.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11298.26,"10th_percentile":11298.26,"90th_percentile":11298.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":27625.87,"10th_percentile":27625.87,"90th_percentile":27625.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23108.59,"10th_percentile":23108.59,"90th_percentile":23108.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"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":66286.87,"maximum":116746.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116746.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77831.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77831.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":81800.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":68011.83},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66286.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77831.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77831.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":73652.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77831.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77831.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77831.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77831.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77831.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77831.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77831.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84829.97},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75810.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77831.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":66706.34,"10th_percentile":66706.34,"90th_percentile":66706.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":68067.68,"10th_percentile":68067.68,"90th_percentile":68067.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45086.16,"10th_percentile":45086.16,"90th_percentile":45086.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44921.28,"maximum":83466.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83466.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55644.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55644.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58482.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":46090.25},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44921.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55644.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55644.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49912.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55644.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55644.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55644.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55644.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55644.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55644.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55644.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57487.56},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51375.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55644.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":171381.92,"10th_percentile":171381.92,"90th_percentile":171381.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32186.51,"10th_percentile":32186.51,"90th_percentile":32186.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33796.24,"maximum":59048.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59048.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39365.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39365.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41373.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":34675.71},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33796.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39365.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39365.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37551.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39365.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39365.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39365.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39365.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39365.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39365.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39365.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43250.4},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38652.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39365.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","code_information":[{"code":"461","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48034.22,"maximum":77464.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77464.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51643.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51643.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54276.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":49284.21},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48034.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51643.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51643.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53371.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51643.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51643.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51643.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51643.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51643.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51643.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51643.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61471.32},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54935.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51643.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","code_information":[{"code":"462","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22414.46,"maximum":38419.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38419.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25613.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25613.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26919.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22997.74},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22414.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25613.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25613.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24904.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25613.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25613.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25613.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25613.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25613.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25613.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25613.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28684.68},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25634.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25613.3,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42273.28,"maximum":79871.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79871.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53247.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53247.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55963.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":43373.35},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42273.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53247.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53247.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46970.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53247.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53247.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53247.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53247.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53247.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53247.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53247.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54098.81},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48347.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53247.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23079.78,"maximum":44621.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44621.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29747.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29747.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31264.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23680.38},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23079.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29747.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29747.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25644.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29747.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29747.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29747.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29747.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29747.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29747.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29747.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29536.13},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26395.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29747.34,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":13444.86,"10th_percentile":13444.86,"90th_percentile":13444.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7920.4,"10th_percentile":7920.4,"90th_percentile":7920.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13587.53,"maximum":27014.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27014.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18928.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13941.12},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13587.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15097.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17388.51},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15539.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18009.83,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Mcc","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39874.97,"maximum":73133.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73133.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48755.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48755.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51242.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":40912.63},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39874.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48755.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48755.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44305.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48755.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48755.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48755.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48755.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48755.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48755.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48755.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51029.6},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45604.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48755.55,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26807.96,"maximum":50238.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50238.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33492.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33492.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35200.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27505.58},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26807.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33492.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33492.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29786.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33492.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33492.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33492.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33492.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33492.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33492.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33492.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34307.22},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30659.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33492.25,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20532.76,"maximum":39620.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39620.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26413.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26413.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27760.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21067.08},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20532.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26413.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26413.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22814.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26413.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26413.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26413.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26413.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26413.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26413.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26413.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26276.59},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23482.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26413.38,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25583.76,"maximum":43509.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43509.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29006.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29006.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30485.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26249.52},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25583.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29006.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29006.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28426.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29006.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29006.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29006.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29006.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29006.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29006.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29006.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32740.56},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29259.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29006.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14758.51,"maximum":28449.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28449.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18966.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18966.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19933.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15142.56},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14758.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18966.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18966.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16398.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18966.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18966.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18966.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18966.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18966.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18966.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18966.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18887.05},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16879.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18966.29,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11945.26,"10th_percentile":11945.26,"90th_percentile":11945.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38017.54,"maximum":67996.00,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67996.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45330.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45330.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47642.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":39006.86},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38017.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45330.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45330.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42241.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45330.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45330.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45330.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45330.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45330.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45330.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45330.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48652.57},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43479.86},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45330.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":29697.02,"10th_percentile":29697.02,"90th_percentile":29697.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":37940.93,"10th_percentile":37940.93,"90th_percentile":37940.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":21443.51,"10th_percentile":21443.51,"90th_percentile":23162.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38350.96,"10th_percentile":38350.96,"90th_percentile":38350.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Cc","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22675.89,"maximum":42321.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42321.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28214.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28214.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29653.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23265.98},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22675.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28214.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28214.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25195.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28214.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28214.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28214.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28214.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28214.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28214.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28214.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29019.25},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25933.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28214.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":35794.21,"10th_percentile":35794.21,"90th_percentile":35794.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":19376.63,"10th_percentile":19376.63,"90th_percentile":19376.63,"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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":87280.52,"10th_percentile":87280.52,"90th_percentile":87280.52,"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":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":15830.8,"10th_percentile":15830.8,"90th_percentile":15830.8,"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":"1 through 10","median_amount":24488.55,"10th_percentile":24488.55,"90th_percentile":24488.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":86607.66,"10th_percentile":86607.66,"90th_percentile":86607.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23369.63,"10th_percentile":23337.43,"90th_percentile":24517.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22918.22,"10th_percentile":21694.44,"90th_percentile":22918.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion Without Cc/Mcc","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18528.95,"maximum":35437.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35437.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23624.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23624.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24829.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19011.13},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18528.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23624.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23624.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20587.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23624.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23624.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23624.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23624.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23624.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23624.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23624.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23712.24},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21191.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23624.92,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":20965.04,"10th_percentile":20965.04,"90th_percentile":20965.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35101.06,"maximum":60688.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60688.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40459.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40459.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42522.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":36014.49},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35101.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40459.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40459.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39001.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40459.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40459.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40459.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40459.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40459.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40459.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40459.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44920.23},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40144.35},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40459.29,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35527.41,"10th_percentile":35527.41,"90th_percentile":35527.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16884.42,"maximum":33178.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33178.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22119.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22119.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23247.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17323.8},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16884.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22119.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22119.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18760.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22119.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22119.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22119.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22119.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22119.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22119.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22119.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21607.67},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19310.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22119.32,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":15678.12,"10th_percentile":15678.12,"90th_percentile":15678.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15812.29,"10th_percentile":15812.29,"90th_percentile":15812.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"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":9103.23,"maximum":18238.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18238.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12159.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12159.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12779.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9340.12},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9103.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12159.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12159.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10114.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12159.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12159.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12159.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12159.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12159.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12159.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12159.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11649.77},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10411.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12159.26,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26916.76,"maximum":49256.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49256.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32837.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32837.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34512.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27617.21},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26916.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32837.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32837.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29907.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32837.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32837.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32837.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32837.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32837.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32837.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32837.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34446.46},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30784.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32837.64,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"478","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18303.52,"maximum":35681.50,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35681.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23787.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23787.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25000.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18779.83},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18303.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23787.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23787.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20337.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23787.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23787.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23787.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23787.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23787.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23787.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23787.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23423.75},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20933.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23787.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12860.08,"10th_percentile":12860.08,"90th_percentile":12860.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"479","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13899.06,"maximum":27494.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27494.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19264.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14260.75},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13899.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15443.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17787.19},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15896.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18329.86,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23020.3,"maximum":41860.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41860.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27907.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27907.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29330.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23619.35},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23020.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27907.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27907.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25578.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27907.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27907.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27907.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27907.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27907.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27907.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27907.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29460.0},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26327.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27907.16,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16241.01,"maximum":30707.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30707.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20471.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20471.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21515.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16663.65},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16241.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20471.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20471.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18045.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20471.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20471.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20471.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20471.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20471.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20471.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20471.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20784.27},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18574.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20471.89,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":17883.1,"10th_percentile":17883.1,"90th_percentile":17883.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12417.34,"maximum":24386.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24386.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16257.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16257.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17086.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12740.47},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12417.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16257.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16257.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13797.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16257.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16257.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16257.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16257.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16257.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16257.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16257.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15890.97},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14201.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16257.84,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19944.92,"maximum":39946.00,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39946.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26630.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26630.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27988.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20463.94},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19944.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26630.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26630.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22161.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26630.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26630.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26630.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26630.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26630.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26630.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26630.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25524.32},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22810.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26630.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":84263.63,"10th_percentile":84263.63,"90th_percentile":84263.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":52899.64,"10th_percentile":52899.64,"90th_percentile":52899.64,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":16647.52,"10th_percentile":16647.52,"90th_percentile":16647.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20588.51,"10th_percentile":20588.51,"90th_percentile":20588.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Mcc","code_information":[{"code":"485","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25232.31,"maximum":46153.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46153.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30769.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30769.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32338.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25888.93},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25232.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30769.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30769.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28035.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30769.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30769.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30769.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30769.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30769.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30769.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30769.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32290.8},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28857.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30769.25,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":28069.1,"10th_percentile":28069.1,"90th_percentile":28069.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Cc","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16599.5,"maximum":30661.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30661.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20440.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20440.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21483.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17031.47},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16599.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20440.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20440.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18443.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20440.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20440.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20440.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20440.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20440.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20440.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20440.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21243.05},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18984.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20440.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17509.6,"10th_percentile":17509.6,"90th_percentile":17509.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12368.03,"maximum":23503.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23503.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15668.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15668.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16467.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12689.88},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12368.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15668.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15668.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13742.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15668.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15668.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15668.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15668.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15668.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15668.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15668.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15827.86},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14145.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15668.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15383.13,"maximum":26267.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26267.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17511.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17511.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18404.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15783.44},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15383.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17511.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17511.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17092.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17511.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17511.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17511.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17511.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17511.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17511.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17511.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19686.41},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17593.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17511.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9694.98,"maximum":17374.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17374.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11582.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11582.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12173.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9947.27},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9694.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11582.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11582.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10772.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11582.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11582.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11582.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11582.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11582.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11582.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11582.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12407.06},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11087.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11582.84,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27794.99,"maximum":52215.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52215.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34810.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34810.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36585.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28518.29},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27794.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34810.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34810.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30883.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34810.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34810.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34810.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34810.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34810.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34810.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34810.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35570.37},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31788.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34810.56,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":24336.04,"10th_percentile":24336.04,"90th_percentile":24336.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28558.99,"10th_percentile":28558.99,"90th_percentile":28558.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18793.52,"maximum":36730.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36730.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24486.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24486.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25735.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19282.58},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18793.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24486.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24486.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20881.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24486.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24486.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24486.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24486.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24486.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24486.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24486.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24050.82},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21493.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24486.83,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18153.7,"10th_percentile":18153.7,"90th_percentile":18153.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14758.51,"maximum":29507.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29507.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19671.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19671.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20675.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15142.56},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14758.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19671.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19671.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16398.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19671.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19671.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19671.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19671.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19671.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19671.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19671.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18887.05},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16879.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19671.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":17496.68,"10th_percentile":17496.68,"90th_percentile":17496.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27554.69,"maximum":51589.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51589.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34393.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34393.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36147.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28271.74},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27554.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34393.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34393.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30616.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34393.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34393.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34393.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34393.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34393.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34393.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34393.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35262.85},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31513.73},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34393.24,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15442.62,"maximum":26744.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26744.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17829.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17829.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18739.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15844.48},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15442.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17829.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17829.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17158.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17829.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17829.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17829.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17829.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17829.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17829.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17829.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19762.54},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17661.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17829.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11479.19,"10th_percentile":11479.19,"90th_percentile":11479.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","code_information":[{"code":"497","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10512.16,"maximum":18622.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18622.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12414.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12414.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13047.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10785.71},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10512.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12414.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12414.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11680.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12414.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12414.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12414.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12414.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12414.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12414.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12414.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13452.83},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12022.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12414.74,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","code_information":[{"code":"498","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19761.76,"maximum":43285.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43285.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28857.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28857.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30328.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20276.02},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19761.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28857.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28857.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21957.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28857.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28857.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28857.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28857.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28857.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28857.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28857.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25289.92},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22601.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28857.25,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":25113.23,"10th_percentile":25113.23,"90th_percentile":25113.23,"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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","code_information":[{"code":"499","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9086.01,"maximum":29620.90,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29620.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19747.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19747.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20754.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9322.45},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9086.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19747.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19747.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10095.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19747.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19747.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19747.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19747.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19747.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19747.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19747.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11627.73},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10391.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19747.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Mcc","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24801.02,"maximum":45304.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45304.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30202.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30202.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31743.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25446.41},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24801.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30202.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30202.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27556.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30202.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30202.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30202.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30202.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30202.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30202.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30202.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31738.86},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28364.41},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30202.84,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13971.07,"maximum":25983.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25983.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17322.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17322.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18205.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14334.64},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13971.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17322.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17322.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15523.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17322.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17322.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17322.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17322.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17322.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17322.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17322.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17879.34},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15978.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17322.49,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":22740.02,"10th_percentile":22740.02,"90th_percentile":22740.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":29641.52,"10th_percentile":29641.52,"90th_percentile":29641.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5346.18,"10th_percentile":5346.18,"90th_percentile":5346.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11774.02,"10th_percentile":11774.02,"90th_percentile":11774.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10935.62,"maximum":20498.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20498.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13665.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13665.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14362.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11220.19},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10935.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13665.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13665.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12150.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13665.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13665.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13665.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13665.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13665.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13665.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13665.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13994.75},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12506.84},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13665.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10586.38,"10th_percentile":10586.38,"90th_percentile":10586.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Mcc","code_information":[{"code":"503","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20715.13,"maximum":40207.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40207.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26805.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26805.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28172.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21254.2},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20715.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26805.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26805.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23016.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26805.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26805.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26805.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26805.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26805.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26805.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26805.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26509.99},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23691.47},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26805.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":14152.12,"10th_percentile":14152.12,"90th_percentile":14152.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13741.73,"maximum":27635.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27635.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18423.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18423.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19363.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14099.33},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13741.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18423.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18423.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15268.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18423.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18423.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18423.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18423.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18423.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18423.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18423.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17585.85},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15716.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18423.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37345.37,"10th_percentile":37345.37,"90th_percentile":37345.37,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9992.96,"10th_percentile":9992.96,"90th_percentile":9992.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13741.73,"maximum":26593.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26593.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17728.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17728.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18633.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14099.33},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13741.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17728.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17728.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15268.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17728.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17728.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17728.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17728.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17728.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17728.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17728.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17585.85},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15716.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17728.9,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Thumb Or Joint Procedures","code_information":[{"code":"506","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11733.23,"maximum":20543.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20543.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13695.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13695.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14394.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12038.56},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11733.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13695.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13695.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13036.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13695.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13695.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13695.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13695.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13695.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13695.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13695.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15015.48},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13419.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13695.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15170.23,"maximum":26778.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26778.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17852.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17852.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18763.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15565.0},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15170.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17852.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17852.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16855.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17852.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17852.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17852.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17852.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17852.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17852.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17852.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19413.95},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17349.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17852.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10102.0,"maximum":22796.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22796.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15197.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15197.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15972.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10364.89},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10102.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15197.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15197.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11224.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15197.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15197.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15197.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15197.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15197.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15197.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15197.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12927.94},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11553.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15197.74,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Arthroscopy","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13748.78,"maximum":17594.86,"payers_information":[{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14106.56},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13748.78},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15276.42},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17594.86},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15724.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12584.06,"maximum":24719.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24719.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16479.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16479.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17320.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12911.54},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12584.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16479.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16479.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13982.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16479.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16479.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16479.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16479.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16479.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16479.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16479.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16104.33},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14392.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16479.68,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11784.11,"maximum":23613.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23613.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15742.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15742.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16545.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12090.76},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11784.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15742.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15742.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13093.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15742.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15742.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15742.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15742.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15742.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15742.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15742.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15080.59},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13477.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15742.34,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":20376.44,"10th_percentile":20376.44,"90th_percentile":20376.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7980.79,"maximum":16085.50,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16085.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10723.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10723.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11270.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8188.47},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7980.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10723.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10723.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8867.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10723.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10723.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10723.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10723.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10723.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10723.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10723.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10213.33},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9127.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10723.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24203.79,"maximum":45605.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45605.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30403.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30403.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31954.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24833.64},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24203.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30403.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30403.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26893.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30403.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30403.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30403.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30403.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30403.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30403.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30403.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30974.57},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27681.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30403.76,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36227.56,"10th_percentile":36227.56,"90th_percentile":36227.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15745.54,"maximum":30484.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30484.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20322.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20322.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21359.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16155.28},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15745.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20322.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20322.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17495.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20322.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20322.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20322.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20322.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20322.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20322.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20322.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20150.2},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18007.84},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20322.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":15645.03,"10th_percentile":15645.03,"90th_percentile":15645.03,"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":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11683.13,"maximum":23100.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23100.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15400.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15400.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16185.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11987.16},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11683.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15400.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15400.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12981.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15400.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15400.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15400.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15400.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15400.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15400.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15400.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14951.37},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13361.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15400.49,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":13436.54,"10th_percentile":13436.54,"90th_percentile":13436.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":76852.97,"10th_percentile":76852.97,"90th_percentile":76852.97,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7508.16,"10th_percentile":7508.16,"90th_percentile":7508.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":796.93,"10th_percentile":796.93,"90th_percentile":796.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"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":28051.73,"maximum":53111.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53111.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35407.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35407.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37213.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28781.71},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28051.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35407.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35407.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31168.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35407.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35407.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35407.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35407.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35407.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35407.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35407.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35898.92},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32082.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35407.89,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 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":40616.75,"10th_percentile":40616.75,"90th_percentile":40616.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":25481.88,"10th_percentile":25481.88,"90th_percentile":25481.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":14157.14,"10th_percentile":14157.14,"90th_percentile":14157.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":35900.93,"10th_percentile":35900.93,"90th_percentile":35900.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15433.23,"maximum":29421.80,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29421.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19614.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19614.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20614.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15834.84},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15433.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19614.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19614.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17148.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19614.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19614.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19614.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19614.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19614.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19614.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19614.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19750.52},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17650.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19614.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":15273.36,"10th_percentile":15273.36,"90th_percentile":15273.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":65461.32,"10th_percentile":65461.32,"90th_percentile":65461.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16919.69,"10th_percentile":16919.69,"90th_percentile":16919.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11217.4,"maximum":22517.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22517.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15011.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15011.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15776.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11509.31},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11217.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15011.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15011.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12463.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15011.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15011.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15011.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15011.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15011.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15011.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15011.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14355.36},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12829.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15011.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":54153.15,"10th_percentile":54153.15,"90th_percentile":54153.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22813.65,"maximum":41286.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41286.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27524.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27524.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28928.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23407.33},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22813.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27524.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27524.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25348.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27524.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27524.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27524.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27524.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27524.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27524.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27524.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29195.55},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26091.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27524.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16501.66,"maximum":31024.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31024.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20682.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20682.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21737.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16931.08},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16501.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20682.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20682.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18335.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20682.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20682.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20682.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20682.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20682.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20682.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20682.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21117.84},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18872.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20682.82,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur With Mcc","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11935.17,"maximum":23523.50,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23523.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15682.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15682.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16482.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12245.76},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11935.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15682.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15682.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13261.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15682.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15682.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15682.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15682.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15682.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15682.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15682.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15273.92},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13650.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15682.33,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6653.84,"10th_percentile":6653.84,"90th_percentile":6653.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur Without Mcc","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6370.7,"maximum":13137.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13137.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8758.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8758.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9204.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6536.48},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6370.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8758.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8758.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7078.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8758.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8758.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8758.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8758.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8758.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8758.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8758.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8152.84},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7286.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8758.02,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7142.94,"10th_percentile":7142.94,"90th_percentile":7142.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10219.49,"10th_percentile":10219.49,"90th_percentile":10219.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":20493.69,"10th_percentile":20493.69,"90th_percentile":20493.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6347.21,"maximum":13157.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13157.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8771.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8771.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9219.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6512.39},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6347.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8771.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8771.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7052.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8771.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8771.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8771.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8771.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8771.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8771.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8771.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8122.79},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7259.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8771.66,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":7228.85,"10th_percentile":7228.85,"90th_percentile":7228.85,"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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4256.04,"10th_percentile":4256.04,"90th_percentile":4256.04,"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":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5818.16,"10th_percentile":5818.16,"90th_percentile":5818.16,"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":"1 through 10","median_amount":6745.43,"10th_percentile":6745.43,"90th_percentile":6745.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","code_information":[{"code":"537","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7192.57,"maximum":15158.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15158.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10105.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10105.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10620.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7379.74},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7192.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10105.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10105.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7991.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10105.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10105.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10105.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10105.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10105.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10105.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10105.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9204.62},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8225.99},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10105.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","code_information":[{"code":"538","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5256.08,"maximum":11966.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11966.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7977.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7977.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8384.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5392.86},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5256.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7977.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7977.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5840.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7977.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7977.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7977.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7977.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7977.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7977.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7977.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6726.42},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6011.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7977.95,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Mcc","code_information":[{"code":"539","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15832.42,"maximum":29005.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29005.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19337.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19337.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20323.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16244.43},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15832.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19337.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19337.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17591.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19337.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19337.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19337.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19337.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19337.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19337.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19337.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20261.39},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18107.21},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19337.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":16722.2,"10th_percentile":16722.2,"90th_percentile":16722.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":191.45,"10th_percentile":191.45,"90th_percentile":191.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Cc","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10131.75,"maximum":19822.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19822.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13888.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10395.4},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10131.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11257.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12966.0},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11587.47},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.82,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10956.29,"10th_percentile":10956.29,"90th_percentile":10956.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10370.13,"10th_percentile":10370.13,"90th_percentile":10370.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis Without Cc/Mcc","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6847.38,"maximum":12882.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12882.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8588.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8588.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9026.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7025.57},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6847.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8588.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8588.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7608.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8588.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8588.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8588.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8588.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8588.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8588.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8588.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8762.87},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7831.21},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8588.01,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14597.26,"maximum":26234.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26234.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17489.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17489.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18381.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14977.12},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14597.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17489.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17489.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16219.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17489.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17489.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17489.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17489.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17489.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17489.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17489.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18680.7},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16694.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17489.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":57534.44,"10th_percentile":57534.44,"90th_percentile":57534.44,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":15598.64,"10th_percentile":15598.64,"90th_percentile":15598.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":7263.7,"10th_percentile":7263.7,"90th_percentile":7263.7,"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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8303.27,"maximum":16163.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16163.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10775.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10775.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11325.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8519.35},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8303.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10775.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10775.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9225.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10775.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10775.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10775.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10775.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10775.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10775.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10775.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10626.03},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9496.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10775.49,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26775.21,"10th_percentile":26775.21,"90th_percentile":26775.21,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9168.7,"10th_percentile":9168.7,"90th_percentile":13965.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7910.59,"10th_percentile":7840.37,"90th_percentile":9178.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10290.1,"10th_percentile":10290.1,"90th_percentile":10290.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5915.14,"maximum":12434.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12434.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8289.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8289.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8712.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6069.07},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5915.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8289.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8289.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6572.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8289.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8289.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8289.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8289.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8289.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8289.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8289.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7569.85},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6765.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8289.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":195.0,"10th_percentile":195.0,"90th_percentile":195.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Mcc","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19777.42,"maximum":35988.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35988.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23992.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23992.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25215.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20292.08},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19777.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23992.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23992.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21974.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23992.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23992.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23992.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23992.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23992.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23992.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23992.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25309.95},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22619.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23992.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":63705.21,"10th_percentile":63705.21,"90th_percentile":63705.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11228.31,"10th_percentile":11228.31,"90th_percentile":11228.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Cc","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9061.75,"maximum":17873.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17873.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11915.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11915.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12523.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9297.56},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9061.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11915.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11915.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10068.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11915.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11915.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11915.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11915.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11915.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11915.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11915.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11596.68},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10363.73},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11915.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":15099.35,"10th_percentile":15099.35,"90th_percentile":15099.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":101094.25,"10th_percentile":101094.25,"90th_percentile":101094.25,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"547","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5840.78,"maximum":13547.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13547.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9031.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9031.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9492.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5992.78},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5840.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9031.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9031.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6489.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9031.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9031.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9031.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9031.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9031.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9031.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9031.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7474.69},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6679.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9031.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5474.38,"10th_percentile":5474.38,"90th_percentile":5474.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Mcc","code_information":[{"code":"548","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15768.24,"maximum":28476.70,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28476.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18984.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18984.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19952.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16178.57},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15768.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18984.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18984.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17520.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18984.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18984.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18984.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18984.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18984.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18984.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18984.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20179.25},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18033.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18984.47,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":191767.81,"10th_percentile":191767.81,"90th_percentile":191767.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":16600.77,"10th_percentile":16600.77,"90th_percentile":16600.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Cc","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9431.98,"maximum":18607.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18607.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12404.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12404.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13037.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9677.43},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9431.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12404.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12404.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10479.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12404.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12404.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12404.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12404.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12404.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12404.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12404.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12070.49},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10787.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12404.74,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9801.33,"10th_percentile":9801.33,"90th_percentile":9801.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis Without Cc/Mcc","code_information":[{"code":"550","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6747.98,"maximum":14064.40,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14064.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9376.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9376.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9854.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6923.58},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6747.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9376.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9376.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7497.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9376.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9376.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9376.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9376.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9376.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9376.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9376.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8635.66},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7717.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9376.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13355.84,"maximum":25001.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25001.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16667.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16667.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17517.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13703.4},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13355.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16667.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16667.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14839.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16667.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16667.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16667.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16667.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16667.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16667.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16667.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17092.01},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15274.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16667.88,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":13711.1,"10th_percentile":13711.1,"90th_percentile":13711.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41387.42,"10th_percentile":41387.42,"90th_percentile":41387.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12964.44,"10th_percentile":12964.44,"90th_percentile":12964.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7544.02,"maximum":15253.60,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15253.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10169.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10169.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10687.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7740.34},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7544.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10169.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10169.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8382.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10169.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10169.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10169.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10169.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10169.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10169.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10169.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9654.38},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8627.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10169.07,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":13009.74,"10th_percentile":13009.74,"90th_percentile":13009.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10120.57,"10th_percentile":10120.57,"90th_percentile":10120.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9016.45,"10th_percentile":9016.45,"90th_percentile":9016.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":26030.22,"10th_percentile":26030.22,"90th_percentile":26030.22,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6237.21,"10th_percentile":6237.21,"90th_percentile":8961.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":59374.01,"10th_percentile":59374.01,"90th_percentile":59374.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3564.12,"10th_percentile":3564.12,"90th_percentile":3564.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8943.67,"10th_percentile":7269.5,"90th_percentile":40980.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7733.47,"10th_percentile":7733.47,"90th_percentile":7733.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7373.97,"10th_percentile":7373.97,"90th_percentile":7373.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7636.06,"10th_percentile":282.87,"90th_percentile":8489.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10224.89,"maximum":19822.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19822.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13888.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10490.97},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10224.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11361.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13085.21},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11694.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.82,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6484.91,"10th_percentile":6484.91,"90th_percentile":6484.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies Without Mcc","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6532.72,"maximum":13464.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13464.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8976.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8976.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9434.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6702.72},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6532.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8976.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8976.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7258.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8976.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8976.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8976.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8976.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8976.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8976.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8976.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8360.19},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7471.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8976.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7408.62,"10th_percentile":7408.62,"90th_percentile":7408.62,"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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":26701.04,"10th_percentile":26701.04,"90th_percentile":26701.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10539.55,"maximum":20169.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20169.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13446.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13446.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14132.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10813.82},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10539.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13446.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13446.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11710.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13446.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13446.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13446.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13446.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13446.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13446.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13446.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13487.89},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12053.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13446.66,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":36858.78,"10th_percentile":36858.78,"90th_percentile":36858.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6391.05,"maximum":13471.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13471.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8980.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8980.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9438.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6557.36},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6391.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8980.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8980.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7101.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8980.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8980.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8980.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8980.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8980.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8980.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8980.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8178.88},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7309.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8980.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":11258.37,"10th_percentile":11258.37,"90th_percentile":11258.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8248.78,"10th_percentile":8248.78,"90th_percentile":8248.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23931.34,"10th_percentile":23931.34,"90th_percentile":23931.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12130.08,"maximum":22421.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22421.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14947.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14947.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15710.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12445.73},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12130.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14947.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14947.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13477.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14947.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14947.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14947.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14947.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14947.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14947.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14947.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15523.34},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13872.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14947.72,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":16200.98,"10th_percentile":16200.98,"90th_percentile":16200.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10881.85,"10th_percentile":10881.85,"90th_percentile":10881.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13180.51,"10th_percentile":13180.51,"90th_percentile":13180.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6761.28,"maximum":14324.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14324.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9549.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9549.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10036.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6937.23},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6761.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9549.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9549.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7512.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9549.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9549.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9549.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9549.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9549.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9549.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9549.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8652.68},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7732.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9549.92,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":12974.88,"10th_percentile":12974.88,"90th_percentile":12974.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":47898.39,"10th_percentile":47898.39,"90th_percentile":47898.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29501.22,"10th_percentile":29501.22,"90th_percentile":29501.22,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":18711.63,"10th_percentile":18711.63,"90th_percentile":18711.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 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":192.28,"10th_percentile":192.28,"90th_percentile":192.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11583.39,"10th_percentile":11583.39,"90th_percentile":11583.39,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6876.02,"10th_percentile":6876.02,"90th_percentile":6876.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3904.67,"10th_percentile":3904.67,"90th_percentile":3904.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7374.54,"10th_percentile":7374.54,"90th_percentile":7374.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6654.13,"10th_percentile":6654.13,"90th_percentile":6654.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14528.38,"maximum":27576.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27576.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18384.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18384.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19322.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14906.45},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14528.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18384.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18384.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16142.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18384.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18384.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18384.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18384.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18384.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18384.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18384.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18592.55},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16615.81},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18384.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":65138.04,"10th_percentile":65138.04,"90th_percentile":65138.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38129.84,"10th_percentile":38129.84,"90th_percentile":38129.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8913.81,"maximum":17501.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17501.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11667.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11667.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12262.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9145.77},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8913.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11667.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11667.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9904.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11667.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11667.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11667.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11667.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11667.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11667.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11667.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11407.36},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10194.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11667.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29817.13,"10th_percentile":29817.13,"90th_percentile":49508.5,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":18613.36,"10th_percentile":18613.36,"90th_percentile":18613.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18742.73,"10th_percentile":18742.73,"90th_percentile":18742.73,"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":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":94529.18,"10th_percentile":94529.18,"90th_percentile":94529.18,"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":11702.01,"10th_percentile":11702.01,"90th_percentile":11702.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8019.27,"10th_percentile":8019.27,"90th_percentile":10726.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9476.38,"10th_percentile":9476.38,"90th_percentile":9476.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":16837.04,"10th_percentile":16837.04,"90th_percentile":16837.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":9935.0,"10th_percentile":9935.0,"90th_percentile":9935.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, 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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20373.3,"10th_percentile":20373.3,"90th_percentile":20373.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6399.66,"maximum":13107.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13107.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8738.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8738.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9183.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6566.19},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6399.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8738.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8738.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7110.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8738.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8738.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8738.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8738.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8738.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8738.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8738.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8189.9},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7319.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8738.02,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12776.33,"10th_percentile":12776.33,"90th_percentile":12776.33,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":72842.22,"10th_percentile":72842.22,"90th_percentile":72842.22,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":95503.25,"10th_percentile":95503.25,"90th_percentile":95503.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9801.33,"10th_percentile":9801.33,"90th_percentile":9801.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":11456.92,"maximum":21574.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21574.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14383.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14383.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15116.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11755.06},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11456.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14383.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14383.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12729.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14383.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14383.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14383.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14383.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14383.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14383.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14383.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14661.88},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13103.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14383.12,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":11980.22,"10th_percentile":11980.22,"90th_percentile":11980.22,"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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":827.91,"10th_percentile":827.91,"90th_percentile":827.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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 Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6995.32,"maximum":14356.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14356.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9570.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9570.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10058.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7177.36},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6995.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9570.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9570.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7772.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9570.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9570.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9570.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9570.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9570.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9570.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9570.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8952.19},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8000.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9570.83,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":7353.91,"10th_percentile":7353.91,"90th_percentile":7353.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 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":8318.75,"10th_percentile":8318.75,"90th_percentile":8318.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3285.12,"10th_percentile":3285.12,"90th_percentile":3285.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":986.1,"10th_percentile":986.1,"90th_percentile":986.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12282.71,"maximum":23194.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23194.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15463.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15463.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16251.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12602.34},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12282.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15463.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15463.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13647.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15463.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15463.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15463.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15463.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15463.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15463.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15463.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15718.68},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14047.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15463.22,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12379.42,"10th_percentile":12379.42,"90th_percentile":12379.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10993.96,"10th_percentile":10993.96,"90th_percentile":10993.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13663.24,"10th_percentile":13663.24,"90th_percentile":13663.24,"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":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7980.79,"maximum":15432.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15432.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10288.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10288.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10812.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8188.47},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7980.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10288.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10288.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8867.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10288.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10288.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10288.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10288.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10288.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10288.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10288.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10213.33},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9127.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10288.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7928.13,"10th_percentile":7928.13,"90th_percentile":7928.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7960.79,"10th_percentile":7960.79,"90th_percentile":7960.79,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":8826.84,"10th_percentile":8826.84,"90th_percentile":8826.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":20981.69,"10th_percentile":20981.69,"90th_percentile":20981.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10250.75,"10th_percentile":10250.75,"90th_percentile":10250.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9071.96,"10th_percentile":9071.96,"90th_percentile":9071.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":538.13,"10th_percentile":538.13,"90th_percentile":538.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5854.87,"maximum":12362.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12362.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8241.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8241.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8661.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6007.23},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5854.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8241.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8241.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6505.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8241.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8241.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8241.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8241.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8241.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8241.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8241.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7492.72},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6696.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8241.61,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6861.25,"10th_percentile":6861.25,"90th_percentile":6861.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23563.51,"maximum":42253.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42253.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28169.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28169.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29605.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24176.7},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23563.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28169.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28169.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26181.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28169.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28169.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28169.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28169.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28169.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28169.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28169.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30155.18},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26949.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28169.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":35808.83,"10th_percentile":35808.83,"90th_percentile":35808.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":24844.38,"10th_percentile":24844.38,"90th_percentile":24844.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14018.47,"10th_percentile":14018.47,"90th_percentile":14018.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13109.28,"maximum":25184.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25184.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16789.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16789.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17645.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13450.42},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13109.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16789.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16789.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14565.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16789.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16789.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16789.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16789.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16789.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16789.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16789.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16776.47},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14992.81},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16789.71,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":43543.76,"10th_percentile":43543.76,"90th_percentile":43543.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8941.99,"maximum":17776.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17776.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11851.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11851.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12455.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9174.68},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8941.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11851.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11851.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9935.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11851.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11851.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11851.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11851.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11851.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11851.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11851.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11443.42},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10226.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11851.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"573","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48199.38,"maximum":91489.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91489.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60993.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60993.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":64103.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":49453.66},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48199.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60993.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60993.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53554.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60993.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60993.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60993.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60993.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60993.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60993.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60993.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61682.68},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55124.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60993.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"574","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27119.49,"maximum":49485.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49485.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32990.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32990.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34672.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27825.21},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27119.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32990.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32990.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30132.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32990.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32990.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32990.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32990.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32990.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32990.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32990.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34705.9},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31015.99},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32990.38,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":42523.83,"10th_percentile":42523.83,"90th_percentile":42523.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"575","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15627.34,"maximum":26650.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26650.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17767.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17767.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18673.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16034.01},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15627.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17767.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17767.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17363.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17767.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17767.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17767.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17767.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17767.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17767.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17767.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19998.94},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17872.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17767.08,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"576","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42227.88,"maximum":68984.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68984.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45989.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45989.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48335.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":43326.77},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42227.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45989.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45989.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46919.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45989.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45989.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45989.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45989.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45989.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45989.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45989.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54040.71},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48295.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45989.82,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"577","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20841.16,"maximum":38293.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38293.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25528.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25528.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26830.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21383.5},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20841.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25528.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25528.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23156.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25528.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25528.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25528.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25528.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25528.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25528.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25528.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26671.26},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23835.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25528.74,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20325.69,"10th_percentile":20325.69,"90th_percentile":20325.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"578","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13230.6,"maximum":24051.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24051.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16034.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16034.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16851.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13574.9},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13230.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16034.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16034.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14700.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16034.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16034.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16034.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16034.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16034.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16034.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16034.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16931.74},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15131.57},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16034.19,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25510.18,"maximum":46309.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46309.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30872.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30872.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32447.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26174.03},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25510.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30872.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30872.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28344.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30872.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30872.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30872.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30872.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30872.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30872.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30872.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32646.4},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29175.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30872.9,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":80820.54,"10th_percentile":80820.54,"90th_percentile":80820.54,"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":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":13128.16,"10th_percentile":13128.16,"90th_percentile":13128.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":41518.83,"10th_percentile":41518.83,"90th_percentile":41518.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13877.14,"maximum":25709.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25709.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17139.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17139.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18013.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14238.27},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13877.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17139.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17139.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15419.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17139.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17139.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17139.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17139.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17139.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17139.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17139.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17759.14},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15871.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17139.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8559.37,"10th_percentile":8559.37,"90th_percentile":8559.37,"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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14375.45,"10th_percentile":14375.45,"90th_percentile":14375.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13267.83,"10th_percentile":13267.83,"90th_percentile":13267.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11264.37,"maximum":21824.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21824.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14549.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14549.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15291.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11557.5},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11264.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14549.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14549.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12515.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14549.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14549.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14549.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14549.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14549.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14549.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14549.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14415.46},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12882.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14549.5,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy With Cc/Mcc","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13706.51,"maximum":28418.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28418.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18945.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18945.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19911.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14063.19},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13706.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18945.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18945.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15229.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18945.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18945.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18945.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18945.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18945.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18945.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18945.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17540.77},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15675.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18945.38,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy Without Cc/Mcc","code_information":[{"code":"583","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12856.46,"maximum":25660.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25660.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17979.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13191.02},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12856.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14284.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16452.92},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14703.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17107.02,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","code_information":[{"code":"584","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16024.97,"maximum":31337.90,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31337.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20891.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20891.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21957.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16441.99},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16024.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20891.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20891.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17805.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20891.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20891.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20891.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20891.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20891.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20891.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20891.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20507.8},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18327.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20891.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15537.33,"maximum":28452.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28452.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18968.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18968.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19935.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15941.65},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15537.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18968.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18968.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17263.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18968.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18968.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18968.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18968.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18968.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18968.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18968.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19883.75},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17769.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18968.11,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Mcc","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16094.64,"maximum":28536.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28536.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19024.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19024.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19994.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16513.47},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16094.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19024.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19024.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17882.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19024.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19024.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19024.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19024.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19024.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19024.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19024.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20596.96},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18407.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19024.48,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12831.51,"10th_percentile":12831.51,"90th_percentile":12831.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9569.74,"maximum":18322.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18322.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12214.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12214.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12837.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9818.77},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9569.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12214.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12214.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10633.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12214.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12214.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12214.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12214.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12214.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12214.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12214.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12246.78},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10944.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12214.72,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7896.16,"10th_percentile":7896.16,"90th_percentile":7896.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5295.92,"10th_percentile":5295.92,"90th_percentile":5295.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9517.68,"10th_percentile":9517.68,"90th_percentile":9517.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8868.22,"10th_percentile":8868.22,"90th_percentile":8868.22,"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":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers Without Cc/Mcc","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6642.31,"maximum":13964.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13964.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9309.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9309.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9784.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6815.16},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6642.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9309.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9309.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7380.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9309.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9309.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9309.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9309.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9309.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9309.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9309.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8500.43},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7596.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9309.9,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders With Mcc","code_information":[{"code":"595","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16554.89,"maximum":31065.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31065.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20710.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20710.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21766.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16985.69},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16554.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20710.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20710.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18394.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20710.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20710.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20710.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20710.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20710.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20710.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20710.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21185.96},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18933.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20710.09,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 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":17442.33,"10th_percentile":17442.33,"90th_percentile":17442.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders Without Mcc","code_information":[{"code":"596","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8461.39,"maximum":16906.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16906.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11271.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11271.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11845.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8681.58},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8461.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11271.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11271.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9401.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11271.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11271.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11271.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11271.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11271.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11271.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11271.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10828.38},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9677.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11271.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Mcc","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13748.78,"maximum":24879.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24879.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16586.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16586.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17431.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14106.56},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13748.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16586.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16586.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15276.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16586.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16586.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16586.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16586.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16586.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16586.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16586.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17594.86},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15724.19},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16586.06,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Cc","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8444.95,"maximum":17572.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17572.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11714.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11714.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12312.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8664.71},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8444.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11714.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11714.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9383.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11714.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11714.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11714.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11714.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11714.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11714.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11714.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10807.34},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9658.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11714.68,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8451.71,"10th_percentile":8451.71,"90th_percentile":8451.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"599","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6691.62,"maximum":12636.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12636.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8424.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8424.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8854.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6865.75},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6691.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8424.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8424.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7435.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8424.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8424.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8424.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8424.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8424.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8424.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8424.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8563.53},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7653.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8424.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders With Cc/Mcc","code_information":[{"code":"600","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7492.36,"maximum":16348.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16348.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10899.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10899.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11455.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7687.33},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7492.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10899.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10899.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8324.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10899.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10899.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10899.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10899.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10899.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10899.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10899.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9588.27},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8568.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10899.14,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4692.51,"maximum":10394.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10394.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6929.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6929.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7283.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":4814.62},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4692.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6929.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6929.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5213.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6929.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6929.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6929.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6929.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6929.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6929.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6929.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6005.19},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5366.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6929.66,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11501.54,"maximum":21526.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21526.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14351.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14351.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15083.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11800.84},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11501.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14351.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14351.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12779.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14351.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14351.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14351.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14351.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14351.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14351.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14351.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14718.98},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13154.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14351.29,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":24153.13,"10th_percentile":24153.13,"90th_percentile":24153.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10982.21,"10th_percentile":10982.21,"90th_percentile":10982.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6087.03,"10th_percentile":6087.03,"90th_percentile":6087.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10495.67,"10th_percentile":8398.9,"90th_percentile":10762.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":87.68,"10th_percentile":87.68,"90th_percentile":87.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":15566.13,"10th_percentile":15566.13,"90th_percentile":15566.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12164.59,"10th_percentile":12164.59,"90th_percentile":12164.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6895.13,"maximum":14020.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14020.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9347.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9347.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9823.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7074.56},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6895.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9347.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9347.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7661.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9347.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9347.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9347.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9347.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9347.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9347.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9347.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8823.98},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7885.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9347.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":12022.97,"10th_percentile":12022.97,"90th_percentile":12022.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5245.22,"10th_percentile":5245.22,"90th_percentile":5245.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6242.91,"10th_percentile":6242.91,"90th_percentile":6624.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26574.68,"10th_percentile":26574.68,"90th_percentile":26574.68,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6206.04,"10th_percentile":6206.04,"90th_percentile":6206.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34796.12,"10th_percentile":34796.12,"90th_percentile":34796.12,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7813.84,"10th_percentile":7813.84,"90th_percentile":7813.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":14641.57,"10th_percentile":14641.57,"90th_percentile":15829.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6473.21,"10th_percentile":5327.23,"90th_percentile":7996.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7309.04,"10th_percentile":7027.64,"90th_percentile":8234.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6784.12,"10th_percentile":6784.12,"90th_percentile":6784.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6206.04,"10th_percentile":4952.91,"90th_percentile":7925.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6967.0,"10th_percentile":6967.0,"90th_percentile":6967.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":8423.09,"10th_percentile":8423.09,"90th_percentile":8463.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6812.36,"10th_percentile":6812.36,"90th_percentile":6812.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"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":11629.12,"maximum":22219.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22219.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14813.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14813.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15568.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11931.75},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11629.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14813.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14813.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12921.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14813.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14813.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14813.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14813.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14813.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14813.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14813.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14882.26},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13299.99},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14813.16,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7230.14,"maximum":14635.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14635.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9757.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9757.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10254.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7418.29},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7230.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9757.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9757.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8033.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9757.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9757.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9757.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9757.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9757.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9757.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9757.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9252.7},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8268.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9757.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 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":905.44,"10th_percentile":905.44,"90th_percentile":905.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8129.99,"10th_percentile":8129.99,"90th_percentile":8129.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders With Mcc","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12602.85,"maximum":22780.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22780.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15186.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15186.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15961.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12930.81},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12602.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15186.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15186.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14003.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15186.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15186.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15186.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15186.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15186.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15186.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15186.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16128.37},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14413.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15186.83,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders Without Mcc","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6765.2,"maximum":14504.90,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14504.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9669.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9669.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10163.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6941.25},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6765.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9669.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9669.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7516.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9669.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9669.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9669.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9669.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9669.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9669.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9669.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8657.69},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7737.21},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9669.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":7638.04,"10th_percentile":7638.04,"90th_percentile":7638.04,"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":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10159.28,"10th_percentile":10159.28,"90th_percentile":10159.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":7515.02,"10th_percentile":7515.02,"90th_percentile":7515.02,"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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":5679.86,"10th_percentile":5679.86,"90th_percentile":5679.86,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures With Cc/Mcc","code_information":[{"code":"614","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17837.01,"maximum":32034.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32034.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21356.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21356.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22445.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18301.18},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17837.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21356.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21356.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19818.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21356.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21356.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21356.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21356.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21356.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21356.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21356.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22826.74},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20399.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21356.52,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures Without Cc/Mcc","code_information":[{"code":"615","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11215.84,"maximum":21226.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21226.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14873.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11507.71},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11215.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12462.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14353.36},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12827.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15124.04,"maximum":27650.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27650.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18433.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18433.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19373.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15517.61},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15124.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18433.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18433.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16804.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18433.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18433.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18433.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18433.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18433.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18433.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18433.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19354.85},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17297.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18433.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":24823.46,"10th_percentile":24823.46,"90th_percentile":24823.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":16405.04,"10th_percentile":16405.04,"90th_percentile":16405.04,"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":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":13136.63,"10th_percentile":11841.75,"90th_percentile":16654.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16548.97,"10th_percentile":16548.97,"90th_percentile":16548.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15821.15,"10th_percentile":15821.15,"90th_percentile":15821.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":44603.53,"10th_percentile":44603.53,"90th_percentile":44603.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":15041.42,"10th_percentile":12516.74,"90th_percentile":28951.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15622.47,"10th_percentile":15622.47,"90th_percentile":15622.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16251.51,"10th_percentile":16251.51,"90th_percentile":16251.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16033.46,"10th_percentile":16033.46,"90th_percentile":16033.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"618","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9745.08,"maximum":21486.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21486.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14324.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14324.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15054.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9998.67},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9745.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14324.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14324.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10827.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14324.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14324.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14324.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14324.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14324.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14324.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14324.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12471.17},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11145.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14324.02,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Mcc","code_information":[{"code":"619","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21340.54,"maximum":41521.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41521.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27680.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27680.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29092.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21895.88},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21340.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27680.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27680.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23711.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27680.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27680.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27680.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27680.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27680.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27680.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27680.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27310.35},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24406.73},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27680.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Cc","code_information":[{"code":"620","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12499.53,"maximum":23968.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23968.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15978.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15978.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16793.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12824.8},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12499.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15978.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15978.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13888.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15978.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15978.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15978.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15978.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15978.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15978.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15978.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15996.15},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14295.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15978.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":45624.78,"10th_percentile":45624.78,"90th_percentile":45624.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10126.97,"10th_percentile":10126.97,"90th_percentile":10126.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity Without Cc/Mcc","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11441.27,"maximum":22714.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22714.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15143.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15143.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15915.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11739.0},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11441.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15143.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15143.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12712.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15143.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15143.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15143.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15143.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15143.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15143.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15143.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14641.85},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13085.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15143.19,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8710.71,"10th_percentile":8710.71,"90th_percentile":8710.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":52813.48,"10th_percentile":52813.48,"90th_percentile":52813.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8137.72,"10th_percentile":8137.72,"90th_percentile":8137.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29305.67,"maximum":50682.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50682.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33788.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33788.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35511.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30068.29},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29305.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33788.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33788.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32561.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33788.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33788.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33788.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33788.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33788.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33788.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33788.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37503.65},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33516.29},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33788.64,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":16965.13,"10th_percentile":16965.13,"90th_percentile":16965.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32314.81,"10th_percentile":32314.81,"90th_percentile":32314.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14981.59,"maximum":26608.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26608.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17738.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17738.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18643.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15371.45},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14981.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17738.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17738.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16646.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17738.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17738.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17738.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17738.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17738.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17738.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17738.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19172.54},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17134.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17738.9,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":13360.47,"10th_percentile":13360.47,"90th_percentile":13360.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6443.81,"10th_percentile":6443.81,"90th_percentile":6443.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"624","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7851.63,"maximum":19216.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19216.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12811.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12811.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13464.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8055.96},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7851.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12811.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12811.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8724.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12811.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12811.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12811.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12811.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12811.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12811.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12811.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10048.05},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8979.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12811.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22440.29,"maximum":43330.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43330.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28887.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28887.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30360.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23024.25},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22440.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28887.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28887.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24933.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28887.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28887.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28887.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28887.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28887.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28887.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28887.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28717.74},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25664.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28887.25,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","code_information":[{"code":"627","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9915.71,"maximum":20258.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20258.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13505.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13505.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14194.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10173.75},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9915.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13505.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13505.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11017.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13505.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13505.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13505.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13505.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13505.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13505.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13505.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12689.54},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11340.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13505.76,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","code_information":[{"code":"628","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30889.15,"maximum":52968.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52968.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35312.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35312.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37113.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31692.97},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30889.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35312.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35312.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34321.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35312.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35312.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35312.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35312.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35312.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35312.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35312.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39530.09},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35327.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35312.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17612.37,"maximum":31857.50,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31857.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21238.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21238.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22321.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18070.69},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17612.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21238.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21238.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19569.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21238.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21238.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21238.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21238.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21238.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21238.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21238.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22539.25},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20142.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21238.33,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":58039.56,"10th_percentile":58039.56,"90th_percentile":58039.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16956.05,"10th_percentile":16956.05,"90th_percentile":16956.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","code_information":[{"code":"630","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10967.71,"maximum":22047.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22047.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14698.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14698.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15448.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11253.12},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10967.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14698.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14698.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12186.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14698.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14698.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14698.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14698.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14698.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14698.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14698.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14035.82},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12543.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14698.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11399.0,"maximum":21736.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21736.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14491.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14491.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15230.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11695.63},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11399.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14491.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14491.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12665.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14491.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14491.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14491.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14491.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14491.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14491.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14491.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14587.76},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13036.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14491.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7478.95,"10th_percentile":7478.95,"90th_percentile":8696.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8137.64,"10th_percentile":8137.64,"90th_percentile":8137.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":25154.51,"10th_percentile":25154.51,"90th_percentile":25154.51,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25319.01,"10th_percentile":25319.01,"90th_percentile":25319.01,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12291.02,"10th_percentile":9141.71,"90th_percentile":18776.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":169753.31,"10th_percentile":169753.31,"90th_percentile":169753.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":14375.18,"10th_percentile":14375.18,"90th_percentile":14375.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12202.51,"10th_percentile":12202.51,"90th_percentile":12202.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9298.42,"10th_percentile":9298.42,"90th_percentile":9298.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7571.2,"10th_percentile":7571.2,"90th_percentile":7571.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":10418.04,"10th_percentile":10418.04,"90th_percentile":10418.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10479.41,"10th_percentile":10479.41,"90th_percentile":11835.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7179.26,"maximum":14365.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14365.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9577.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9577.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10065.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7366.09},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7179.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9577.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9577.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7976.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9577.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9577.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9577.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9577.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9577.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9577.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9577.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9187.59},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8210.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9577.19,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":8211.67,"10th_percentile":8211.67,"90th_percentile":8211.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5069.15,"10th_percentile":5069.15,"90th_percentile":5069.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5892.53,"10th_percentile":5892.53,"90th_percentile":5892.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":28043.72,"10th_percentile":19153.16,"90th_percentile":44194.38,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17429.79,"10th_percentile":16125.11,"90th_percentile":24562.53,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4496.16,"10th_percentile":4245.79,"90th_percentile":7431.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12560.73,"10th_percentile":12560.73,"90th_percentile":12560.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8044.96,"10th_percentile":8044.96,"90th_percentile":8044.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":25852.97,"10th_percentile":25143.08,"90th_percentile":57458.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"21","median_amount":5069.15,"10th_percentile":196.15,"90th_percentile":8399.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7498.87,"10th_percentile":7498.87,"90th_percentile":8438.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4717.01,"10th_percentile":4717.01,"90th_percentile":7995.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":205.96,"10th_percentile":205.96,"90th_percentile":205.96,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":7385.11,"10th_percentile":7385.11,"90th_percentile":7385.11,"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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7923.52,"10th_percentile":6314.94,"90th_percentile":8500.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4904.63,"maximum":10615.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10615.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7076.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7076.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7437.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5032.26},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4904.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7076.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7076.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5449.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7076.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7076.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7076.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7076.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7076.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7076.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7076.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6276.65},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5609.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7076.95,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":7192.42,"10th_percentile":7192.42,"90th_percentile":7192.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37769.0,"10th_percentile":37769.0,"90th_percentile":37769.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":19439.97,"10th_percentile":19439.97,"90th_percentile":19439.97,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4496.16,"10th_percentile":4496.16,"90th_percentile":5069.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4496.16,"10th_percentile":4496.16,"90th_percentile":4496.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10395.53,"maximum":20358.20,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20358.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13572.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13572.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14264.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10666.05},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10395.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13572.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13572.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11550.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13572.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13572.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13572.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13572.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13572.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13572.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13572.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13303.58},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11889.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13572.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10239.94,"10th_percentile":10239.94,"90th_percentile":10239.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11328.61,"10th_percentile":9689.61,"90th_percentile":11981.85,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8284.1,"10th_percentile":8284.1,"90th_percentile":8284.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12019.81,"10th_percentile":12019.81,"90th_percentile":12019.81,"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":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11213.02,"10th_percentile":11213.02,"90th_percentile":11213.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":18487.56,"10th_percentile":18487.56,"90th_percentile":18487.56,"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":"1 through 10","median_amount":10348.61,"10th_percentile":10348.61,"90th_percentile":10348.61,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6681.98,"10th_percentile":5517.06,"90th_percentile":8918.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11232.37,"10th_percentile":11106.53,"90th_percentile":11233.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9782.8,"10th_percentile":9782.8,"90th_percentile":9782.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9491.55,"10th_percentile":1286.72,"90th_percentile":11368.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"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":6117.09,"maximum":12756.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12756.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8938.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6276.27},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6117.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6796.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7828.29},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6995.99},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8504.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":3818.4,"10th_percentile":3818.4,"90th_percentile":3818.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":7070.61,"10th_percentile":7070.61,"90th_percentile":7070.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":13120.26,"10th_percentile":13120.26,"90th_percentile":13120.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16008.07,"10th_percentile":16008.07,"90th_percentile":16008.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5719.37,"10th_percentile":4963.43,"90th_percentile":8569.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":29651.48,"10th_percentile":25042.08,"90th_percentile":31856.96,"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":7158.6,"10th_percentile":7158.6,"90th_percentile":7158.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6046.12,"10th_percentile":6046.12,"90th_percentile":52580.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6384.64,"10th_percentile":6384.64,"90th_percentile":6384.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6933.61,"10th_percentile":288.71,"90th_percentile":7042.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9084.04,"10th_percentile":9084.04,"90th_percentile":9084.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":7868.93,"10th_percentile":7868.93,"90th_percentile":7868.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":4304.67,"10th_percentile":4304.67,"90th_percentile":4304.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5791.38,"10th_percentile":5258.96,"90th_percentile":7112.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9714.55,"maximum":21537.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21537.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14358.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14358.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15090.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9967.35},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9714.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14358.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14358.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10793.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14358.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14358.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14358.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14358.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14358.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14358.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14358.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12432.1},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11110.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14358.57,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12667.13,"10th_percentile":12667.13,"90th_percentile":12667.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12972.3,"maximum":24592.70,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24592.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16395.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16395.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17231.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13309.88},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12972.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16395.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16395.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14413.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16395.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16395.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16395.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16395.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16395.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16395.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16395.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16601.17},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14836.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16395.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":13860.29,"10th_percentile":13860.29,"90th_percentile":13860.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":17147.9,"10th_percentile":17147.9,"90th_percentile":17147.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12975.43,"10th_percentile":12975.43,"90th_percentile":12975.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5985.77,"10th_percentile":5985.77,"90th_percentile":5985.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":501.06,"10th_percentile":501.06,"90th_percentile":501.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13112.21,"10th_percentile":13112.21,"90th_percentile":13112.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8089.59,"maximum":16122.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16122.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11296.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8300.1},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8089.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8988.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10352.57},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9251.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.22,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4659.65,"10th_percentile":4659.65,"90th_percentile":4659.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8980.52,"10th_percentile":8980.52,"90th_percentile":8980.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7397.83,"10th_percentile":7397.83,"90th_percentile":7397.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1058.09,"10th_percentile":1058.09,"90th_percentile":1058.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9095.62,"10th_percentile":9095.62,"90th_percentile":9095.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6097.52,"maximum":12621.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12621.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8414.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8414.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8843.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6256.2},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6097.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8414.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8414.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6775.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8414.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8414.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8414.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8414.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8414.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8414.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8414.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7803.24},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6973.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8414.35,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4028.92,"10th_percentile":4028.92,"90th_percentile":4028.92,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5615.51,"10th_percentile":5615.51,"90th_percentile":5615.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis With Mcc","code_information":[{"code":"650","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36060.69,"maximum":66259.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66259.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44173.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44173.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46426.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":36999.09},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36060.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44173.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44173.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40067.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44173.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44173.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44173.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44173.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44173.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44173.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44173.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46148.32},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41241.86},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44173.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis Without Mcc","code_information":[{"code":"651","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27178.19,"maximum":52682.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52682.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35121.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35121.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36912.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27885.45},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27178.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35121.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35121.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30198.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35121.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35121.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35121.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35121.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35121.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35121.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35121.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34781.03},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31083.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35121.5,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Mcc","code_information":[{"code":"653","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43631.33,"maximum":73010.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73010.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48673.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48673.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":51156.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":44766.73},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43631.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48673.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48673.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48479.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48673.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48673.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48673.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48673.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48673.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48673.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48673.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55836.76},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49900.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48673.72,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Cc","code_information":[{"code":"654","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22088.06,"maximum":40319.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40319.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26879.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26879.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28250.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22662.85},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22088.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26879.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26879.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24542.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26879.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26879.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26879.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26879.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26879.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26879.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26879.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28266.97},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25261.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26879.79,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures Without Cc/Mcc","code_information":[{"code":"655","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16259.01,"maximum":31009.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31009.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20672.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20672.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21727.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16682.12},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16259.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20672.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20672.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18065.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20672.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20672.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20672.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20672.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20672.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20672.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20672.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20807.31},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18595.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20672.82,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":26213.88,"10th_percentile":26213.88,"90th_percentile":26213.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Mcc","code_information":[{"code":"656","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25499.22,"maximum":45563.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45563.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30375.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30375.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31924.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26162.78},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25499.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30375.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30375.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28332.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30375.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30375.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30375.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30375.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30375.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30375.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30375.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32632.38},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29162.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30375.58,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Cc","code_information":[{"code":"657","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14308.43,"maximum":27100.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27100.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18067.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18067.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18988.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14680.78},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14308.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18067.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18067.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15898.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18067.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18067.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18067.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18067.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18067.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18067.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18067.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18311.08},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16364.26},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18067.11,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":67273.6,"10th_percentile":67273.6,"90th_percentile":67273.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","code_information":[{"code":"658","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11771.58,"maximum":23306.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23306.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15537.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15537.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16330.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12077.91},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11771.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15537.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15537.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13079.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15537.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15537.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15537.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15537.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15537.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15537.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15537.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15064.57},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13462.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15537.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":91820.75,"10th_percentile":91820.75,"90th_percentile":91820.75,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20227.49,"maximum":36795.70,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36795.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24530.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24530.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25781.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20753.87},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20227.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24530.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24530.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22474.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24530.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24530.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24530.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24530.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24530.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24530.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24530.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25885.93},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23133.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24530.47,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":32275.73,"10th_percentile":32275.73,"90th_percentile":32275.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20457.47,"10th_percentile":20457.47,"90th_percentile":20457.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":23134.65,"10th_percentile":23134.65,"90th_percentile":23134.65,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20115.48,"10th_percentile":20115.48,"90th_percentile":20115.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10487.89,"maximum":20168.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20168.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13445.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13445.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14131.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10760.82},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10487.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13445.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13445.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11653.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13445.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13445.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13445.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13445.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13445.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13445.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13445.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13421.78},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11994.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13445.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":17450.03,"10th_percentile":17450.03,"90th_percentile":17450.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10518.68,"10th_percentile":10518.68,"90th_percentile":10518.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40908.36,"10th_percentile":30336.28,"90th_percentile":66130.21,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12100.89,"10th_percentile":12100.89,"90th_percentile":12100.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":28165.27,"10th_percentile":28165.27,"90th_percentile":28165.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":12187.62,"10th_percentile":12187.62,"90th_percentile":12187.62,"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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11136.72,"10th_percentile":11136.72,"90th_percentile":11136.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"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":8035.58,"maximum":16264.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16264.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10842.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10842.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11395.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8244.69},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8035.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10842.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10842.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8928.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10842.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10842.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10842.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10842.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10842.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10842.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10842.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10283.45},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9190.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10842.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":7199.24,"10th_percentile":7199.24,"90th_percentile":7199.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":40978.99,"10th_percentile":40978.99,"90th_percentile":40978.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7334.01,"10th_percentile":7334.01,"90th_percentile":7334.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":10037.79,"10th_percentile":10037.79,"90th_percentile":10037.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Mcc","code_information":[{"code":"662","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24416.7,"maximum":43895.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43895.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29263.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29263.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30756.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25052.09},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24416.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29263.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29263.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27129.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29263.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29263.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29263.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29263.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29263.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29263.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29263.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31247.03},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27924.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29263.65,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Cc","code_information":[{"code":"663","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11954.74,"maximum":22875.70,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22875.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15250.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15250.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16028.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12265.84},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11954.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15250.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15250.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13283.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15250.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15250.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15250.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15250.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15250.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15250.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15250.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15298.96},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13672.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15250.47,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy Without Cc/Mcc","code_information":[{"code":"667","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8044.19,"maximum":17229.70,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17229.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11486.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11486.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12072.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8253.52},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8044.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11486.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11486.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8937.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11486.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11486.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11486.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11486.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11486.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11486.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11486.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10294.47},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9199.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11486.47,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Mcc","code_information":[{"code":"668","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22825.39,"maximum":41965.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41965.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27977.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27977.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29404.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23419.37},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22825.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27977.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27977.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25361.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27977.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27977.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27977.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27977.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27977.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27977.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27977.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29210.57},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26104.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27977.16,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":23705.19,"10th_percentile":23705.19,"90th_percentile":23705.19,"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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26457.77,"10th_percentile":26457.77,"90th_percentile":26457.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23699.1,"10th_percentile":23699.1,"90th_percentile":23699.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13009.16,"10th_percentile":13009.16,"90th_percentile":13009.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Cc","code_information":[{"code":"669","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12112.86,"maximum":23309.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23309.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15539.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15539.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16332.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12428.07},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12112.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15539.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15539.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13458.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15539.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15539.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15539.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15539.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15539.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15539.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15539.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15501.31},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13853.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15539.59,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11391.05,"10th_percentile":11391.05,"90th_percentile":11391.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":367.49,"10th_percentile":367.49,"90th_percentile":367.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures Without Cc/Mcc","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7479.83,"maximum":15471.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15471.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10314.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10314.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10840.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7674.48},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7479.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10314.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10314.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8310.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10314.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10314.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10314.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10314.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10314.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10314.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10314.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9572.25},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8554.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10314.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":8575.86,"10th_percentile":8575.86,"90th_percentile":8575.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures With Cc/Mcc","code_information":[{"code":"671","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13491.25,"maximum":26623.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26623.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17748.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17748.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18654.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13842.34},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13491.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17748.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17748.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14990.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17748.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17748.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17748.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17748.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17748.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17748.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17748.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17265.3},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15429.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17748.9,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures Without Cc/Mcc","code_information":[{"code":"672","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8565.49,"maximum":16865.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16865.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11243.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11243.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11817.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8788.39},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8565.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11243.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11243.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9517.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11243.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11243.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11243.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11243.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11243.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11243.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11243.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10961.6},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9796.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11243.72,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Mcc","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32796.68,"maximum":59443.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59443.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39629.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39629.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41650.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":33650.14},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32796.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39629.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39629.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36440.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39629.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39629.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39629.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39629.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39629.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39629.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39629.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41971.23},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37508.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39629.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":35823.39,"10th_percentile":35823.39,"90th_percentile":35823.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36544.86,"10th_percentile":36544.86,"90th_percentile":36544.86,"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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9473.54,"10th_percentile":9473.54,"90th_percentile":9473.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34240.65,"10th_percentile":34240.65,"90th_percentile":34240.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":13853.19,"10th_percentile":13853.19,"90th_percentile":13853.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32109.75,"10th_percentile":32109.75,"90th_percentile":32109.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31913.36,"10th_percentile":31913.36,"90th_percentile":31913.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10559.41,"10th_percentile":10559.41,"90th_percentile":10559.41,"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: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31620.34,"10th_percentile":31620.34,"90th_percentile":31620.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18067.92,"maximum":34036.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34036.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22691.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22691.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23848.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18538.1},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18067.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22691.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22691.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20075.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22691.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22691.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22691.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22691.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22691.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22691.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22691.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23122.24},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20663.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22691.2,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9263.65,"10th_percentile":9263.65,"90th_percentile":9263.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18782.76,"10th_percentile":18782.76,"90th_percentile":18782.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5691.03,"10th_percentile":5691.03,"90th_percentile":5691.03,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12251.4,"maximum":24528.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24528.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16352.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16352.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17186.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12570.22},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12251.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16352.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16352.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13612.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16352.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16352.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16352.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16352.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16352.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16352.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16352.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15678.61},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14011.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16352.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11756.71,"maximum":22341.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22341.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14894.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14894.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15653.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12062.65},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11756.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14894.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14894.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13063.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14894.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14894.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14894.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14894.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14894.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14894.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14894.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15045.53},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13445.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14894.08,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8900.55,"10th_percentile":6424.9,"90th_percentile":10925.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12679.34,"10th_percentile":12679.34,"90th_percentile":12679.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12653.87,"10th_percentile":12653.87,"90th_percentile":12653.87,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":47197.31,"10th_percentile":47197.31,"90th_percentile":47197.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8900.55,"10th_percentile":8633.38,"90th_percentile":10328.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11438.1,"10th_percentile":11438.1,"90th_percentile":11438.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 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":11665.04,"10th_percentile":11665.04,"90th_percentile":11665.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6583.57,"10th_percentile":6583.57,"90th_percentile":6583.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11782.11,"10th_percentile":627.17,"90th_percentile":12683.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":14127.57,"10th_percentile":14127.57,"90th_percentile":14127.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8806.06,"10th_percentile":8806.06,"90th_percentile":8806.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":18760.25,"10th_percentile":18760.25,"90th_percentile":18760.25,"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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10916.25,"10th_percentile":5470.83,"90th_percentile":13133.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6957.75,"maximum":14087.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14087.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9391.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9391.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9870.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7138.81},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6957.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9391.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9391.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7730.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9391.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9391.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9391.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9391.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9391.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9391.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9391.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8904.11},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7957.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9391.72,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":12104.67,"10th_percentile":12104.67,"90th_percentile":12104.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8900.55,"10th_percentile":8900.55,"90th_percentile":8900.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7098.61,"10th_percentile":6741.83,"90th_percentile":8339.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24716.81,"10th_percentile":24716.81,"90th_percentile":24716.81,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6954.75,"10th_percentile":1220.6,"90th_percentile":9779.36,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8069.78,"10th_percentile":8069.78,"90th_percentile":8121.56,"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":"1 through 10","median_amount":7876.49,"10th_percentile":7876.49,"90th_percentile":7876.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":29792.23,"10th_percentile":29792.23,"90th_percentile":95920.31,"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":"1 through 10","median_amount":8045.08,"10th_percentile":8045.08,"90th_percentile":8045.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8948.41,"10th_percentile":8948.41,"90th_percentile":8948.41,"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":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8637.75,"10th_percentile":6345.79,"90th_percentile":10558.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7251.31,"10th_percentile":6516.69,"90th_percentile":7281.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":375.27,"10th_percentile":375.27,"90th_percentile":375.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5866.38,"10th_percentile":3650.31,"90th_percentile":7908.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4755.13,"maximum":10330.40,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10330.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6886.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6886.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7238.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":4878.87},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4755.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6886.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6886.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5283.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6886.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6886.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6886.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6886.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6886.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6886.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6886.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6085.33},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5438.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6886.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4608.02,"10th_percentile":4608.02,"90th_percentile":4608.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Mcc","code_information":[{"code":"686","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14759.29,"maximum":26742.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26742.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17828.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17828.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18737.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15143.37},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14759.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17828.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17828.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16399.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17828.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17828.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17828.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17828.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17828.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17828.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17828.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18888.06},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16879.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17828.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15200.48,"10th_percentile":15200.48,"90th_percentile":15200.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Cc","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8239.09,"maximum":16433.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16433.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10955.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10955.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11514.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8453.49},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8239.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10955.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10955.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9154.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10955.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10955.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10955.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10955.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10955.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10955.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10955.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10543.89},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9422.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10955.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6199.89,"10th_percentile":6199.89,"90th_percentile":6199.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","code_information":[{"code":"688","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5668.58,"maximum":12921.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12921.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8614.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8614.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9053.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5816.09},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5668.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8614.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8614.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6298.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8614.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8614.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8614.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8614.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8614.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8614.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8614.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7254.31},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6483.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8614.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9161.15,"maximum":17967.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17967.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11978.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11978.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12589.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9399.55},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9161.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11978.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11978.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10179.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11978.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11978.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11978.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11978.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11978.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11978.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11978.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11723.9},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10477.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11978.34,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":12535.86,"10th_percentile":12535.86,"90th_percentile":12535.86,"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":"1 through 10","median_amount":9614.79,"10th_percentile":7234.95,"90th_percentile":10113.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8441.35,"10th_percentile":8441.35,"90th_percentile":8441.35,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38923.45,"10th_percentile":38923.45,"90th_percentile":38923.45,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7695.51,"10th_percentile":5381.91,"90th_percentile":14755.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10297.04,"10th_percentile":10297.04,"90th_percentile":10297.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10000.56,"10th_percentile":10000.56,"90th_percentile":10484.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 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":14352.71,"10th_percentile":14352.71,"90th_percentile":14352.71},{"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":10103.66,"10th_percentile":10103.66,"90th_percentile":10105.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7625.01,"10th_percentile":7625.01,"90th_percentile":7625.01,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10020.01,"10th_percentile":9832.11,"90th_percentile":10505.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9331.25,"10th_percentile":8651.36,"90th_percentile":9611.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8461.18,"10th_percentile":8461.18,"90th_percentile":8461.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8633.67,"10th_percentile":160.37,"90th_percentile":10140.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6282.25,"maximum":13183.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13183.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8788.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8788.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9237.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6445.73},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6282.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8788.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8788.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6980.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8788.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8788.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8788.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8788.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8788.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8788.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8788.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8039.64},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7184.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8788.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6303.86,"10th_percentile":6303.86,"90th_percentile":6303.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7519.81,"10th_percentile":6904.49,"90th_percentile":7813.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":33305.95,"10th_percentile":33305.95,"90th_percentile":33305.95,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5709.37,"10th_percentile":5709.37,"90th_percentile":5709.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":236.95,"10th_percentile":236.95,"90th_percentile":236.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 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":7238.99,"10th_percentile":7238.99,"90th_percentile":7247.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5680.52,"10th_percentile":5680.52,"90th_percentile":5680.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":7180.01,"10th_percentile":238.21,"90th_percentile":7205.33,"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":"1 through 10","median_amount":501.06,"10th_percentile":501.06,"90th_percentile":501.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6527.89,"10th_percentile":6527.89,"90th_percentile":7039.29,"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":7268.47,"10th_percentile":7268.47,"90th_percentile":7268.47,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":7109.14,"10th_percentile":7109.14,"90th_percentile":7109.14,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6460.75,"10th_percentile":876.51,"90th_percentile":7258.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones With Mcc","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11508.58,"maximum":20479.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20479.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13653.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13653.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14349.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11808.07},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11508.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13653.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13653.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12787.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13653.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13653.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13653.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13653.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13653.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13653.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13653.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14728.0},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13162.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13653.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6116.31,"maximum":12804.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12804.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8536.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8536.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8971.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6275.47},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6116.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8536.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8536.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6795.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8536.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8536.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8536.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8536.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8536.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8536.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8536.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7827.28},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6995.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8536.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":5260.14,"10th_percentile":5260.14,"90th_percentile":5260.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":30674.56,"10th_percentile":30674.56,"90th_percentile":30674.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11598.13,"10th_percentile":11598.13,"90th_percentile":11598.13,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":19760.79,"10th_percentile":19760.79,"90th_percentile":19760.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7024.92,"10th_percentile":7024.92,"90th_percentile":7024.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6297.25,"10th_percentile":6297.25,"90th_percentile":6297.25,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms With Mcc","code_information":[{"code":"695","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8826.93,"maximum":17742.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17742.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11828.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11828.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12431.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9056.63},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8826.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11828.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11828.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9807.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11828.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11828.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11828.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11828.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11828.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11828.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11828.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11296.17},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10095.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11828.32,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7935.73,"10th_percentile":7935.73,"90th_percentile":7935.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10042.97,"10th_percentile":10042.97,"90th_percentile":10042.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms Without Mcc","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5414.19,"maximum":11540.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11540.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7693.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7693.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8085.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5555.08},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5414.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7693.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7693.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6015.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7693.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7693.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7693.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7693.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7693.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7693.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7693.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6928.76},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6192.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7693.38,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":105.84,"10th_percentile":105.84,"90th_percentile":105.84,"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] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":16580.72,"10th_percentile":16580.72,"90th_percentile":16580.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Stricture","code_information":[{"code":"697","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7841.46,"maximum":16842.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16842.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11228.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11228.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11800.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8045.52},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7841.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11228.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11228.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8712.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11228.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11228.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11228.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11228.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11228.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11228.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11228.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10035.03},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8968.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11228.26,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4746.66,"10th_percentile":4746.66,"90th_percentile":4746.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13157.03,"maximum":24705.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24705.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16470.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16470.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17310.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13499.41},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13157.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16470.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16470.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14618.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16470.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16470.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16470.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16470.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16470.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16470.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16470.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16837.58},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15047.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16470.59,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":21356.91,"10th_percentile":21356.91,"90th_percentile":21356.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11805.83,"10th_percentile":7313.8,"90th_percentile":14552.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14051.66,"10th_percentile":14051.66,"90th_percentile":40997.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7666.22,"10th_percentile":5200.78,"90th_percentile":15698.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13629.82,"10th_percentile":13629.82,"90th_percentile":13629.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13926.14,"10th_percentile":13926.14,"90th_percentile":13926.14,"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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":15692.38,"10th_percentile":15692.38,"90th_percentile":15692.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":14480.43,"10th_percentile":14480.43,"90th_percentile":33790.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13921.05,"10th_percentile":12357.05,"90th_percentile":14382.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":15626.41,"10th_percentile":15626.41,"90th_percentile":17417.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12427.23,"10th_percentile":12427.23,"90th_percentile":14103.24,"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":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6809.62,"10th_percentile":6809.62,"90th_percentile":6809.62,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14069.72,"10th_percentile":12246.92,"90th_percentile":14356.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7982.35,"maximum":15985.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15985.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10657.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10657.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11200.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8190.07},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7982.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10657.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10657.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8869.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10657.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10657.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10657.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10657.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10657.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10657.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10657.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10215.34},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9129.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10657.3,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7249.09,"10th_percentile":7249.09,"90th_percentile":10114.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9634.58,"10th_percentile":9634.58,"90th_percentile":9634.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":237.08,"10th_percentile":237.08,"90th_percentile":237.08,"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":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":20335.05,"10th_percentile":20335.05,"90th_percentile":20335.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9000.89,"10th_percentile":9000.89,"90th_percentile":9000.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10458.87,"10th_percentile":10458.87,"90th_percentile":10458.87,"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":"0","additional_payer_notes":"No services performed during 15-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":7207.08,"10th_percentile":7207.08,"90th_percentile":7207.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7276.91,"10th_percentile":7276.91,"90th_percentile":7276.91,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":931.53,"10th_percentile":931.53,"90th_percentile":8935.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12387.87,"10th_percentile":12387.87,"90th_percentile":12387.87,"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."}]}]},{"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":5432.98,"maximum":11552.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11552.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8094.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5574.36},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5432.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6036.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6952.8},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6213.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7701.56,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures With Cc/Mcc","code_information":[{"code":"707","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15189.01,"maximum":29423.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29423.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19615.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19615.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20615.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15584.27},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15189.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19615.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19615.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16876.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19615.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19615.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19615.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19615.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19615.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19615.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19615.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19437.99},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17371.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19615.44,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":86024.83,"10th_percentile":86024.83,"90th_percentile":86024.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":92931.2,"10th_percentile":92931.2,"90th_percentile":92931.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures Without Cc/Mcc","code_information":[{"code":"708","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11603.29,"maximum":23066.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23066.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15377.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15377.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16162.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11905.24},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11603.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15377.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15377.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12892.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15377.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15377.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15377.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15377.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15377.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15377.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15377.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14849.2},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13270.44},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15377.76,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12405.45,"10th_percentile":12405.45,"90th_percentile":12405.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11732.45,"10th_percentile":11732.45,"90th_percentile":11732.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures With Cc/Mcc","code_information":[{"code":"709","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17588.1,"maximum":33879.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33879.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22586.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22586.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23738.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18045.79},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17588.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22586.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22586.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19542.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22586.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22586.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22586.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22586.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22586.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22586.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22586.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22508.2},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20115.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22586.64,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures Without Cc/Mcc","code_information":[{"code":"710","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11751.23,"maximum":21252.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21252.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14168.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14168.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14891.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12057.03},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11751.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14168.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14168.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13056.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14168.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14168.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14168.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14168.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14168.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14168.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14168.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15038.52},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13439.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14168.55,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures With Cc/Mcc","code_information":[{"code":"711","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14954.97,"maximum":30561.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30561.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20374.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20374.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21413.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15344.14},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14954.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20374.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20374.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16616.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20374.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20374.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20374.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20374.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20374.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20374.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20374.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19138.48},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17103.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20374.61,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures Without Cc/Mcc","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8372.15,"maximum":17141.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17141.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11427.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11427.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12010.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8590.02},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8372.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11427.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11427.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9302.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11427.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11427.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11427.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11427.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11427.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11427.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11427.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10714.18},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9575.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11427.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":69609.64,"10th_percentile":69609.64,"90th_percentile":69609.64,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"1 through 10","median_amount":11626.91,"10th_percentile":11626.91,"90th_percentile":11626.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12127.26,"10th_percentile":12121.16,"90th_percentile":12145.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":13458.44,"10th_percentile":13458.44,"90th_percentile":13458.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy Without Cc/Mcc","code_information":[{"code":"714","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7354.6,"maximum":16564.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16564.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11042.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11042.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11605.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7545.98},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7354.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11042.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11042.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8171.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11042.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11042.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11042.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11042.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11042.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11042.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11042.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9411.97},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8411.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11042.79,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","code_information":[{"code":"715","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17675.77,"maximum":32655.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32655.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21770.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21770.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22880.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18135.74},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17675.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21770.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21770.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19639.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21770.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21770.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21770.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21770.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21770.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21770.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21770.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22620.39},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20215.41},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21770.2,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":38298.51,"10th_percentile":38298.51,"90th_percentile":38298.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7578.46,"maximum":15196.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15196.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10130.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10130.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10647.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7775.67},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7578.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10130.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10130.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8420.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10130.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10130.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10130.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10130.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10130.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10130.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10130.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9698.46},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8667.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10130.88,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7900.75,"10th_percentile":7900.75,"90th_percentile":7900.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7320.26,"10th_percentile":6198.22,"90th_percentile":7900.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":43623.29,"10th_percentile":39330.62,"90th_percentile":46488.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"12","median_amount":6718.36,"10th_percentile":6150.15,"90th_percentile":8170.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7853.32,"10th_percentile":7853.32,"90th_percentile":7853.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Mcc","code_information":[{"code":"799","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37215.23,"maximum":63907.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63907.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42604.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42604.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44777.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":38183.67},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37215.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42604.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42604.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41350.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42604.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42604.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42604.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42604.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42604.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42604.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42604.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47625.83},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42562.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42604.95,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Cc","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22805.83,"maximum":40457.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40457.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26971.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26971.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28347.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23399.3},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22805.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26971.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26971.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25339.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26971.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26971.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26971.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26971.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26971.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26971.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26971.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29185.53},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26082.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26971.61,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures Without Cc/Mcc","code_information":[{"code":"801","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12850.19,"maximum":28176.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28176.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18784.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18784.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19742.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13184.59},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12850.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18784.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18784.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14278.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18784.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18784.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18784.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18784.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18784.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18784.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18784.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16444.91},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14696.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18784.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","code_information":[{"code":"802","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28057.99,"maximum":56477.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56477.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37651.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37651.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39571.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28788.14},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28057.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37651.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37651.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31175.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37651.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37651.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37651.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37651.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37651.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37651.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37651.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35906.94},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32089.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37651.74,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","code_information":[{"code":"803","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13931.94,"maximum":27494.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27494.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19264.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14294.48},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13931.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15479.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17829.26},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15933.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18329.86,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","code_information":[{"code":"804","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8653.16,"maximum":20636.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20636.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13757.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13757.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14459.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8878.34},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8653.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13757.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13757.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9614.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13757.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13757.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13757.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13757.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13757.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13757.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13757.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11073.79},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9896.44},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13757.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7810.93,"maximum":16861.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16861.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11240.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11240.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11814.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8014.19},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7810.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11240.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11240.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8678.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11240.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11240.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11240.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11240.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11240.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11240.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11240.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9995.96},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8933.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11240.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":8627.47,"10th_percentile":8627.47,"90th_percentile":8627.47,"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":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6201.58,"10th_percentile":5515.59,"90th_percentile":7297.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23481.96,"10th_percentile":23481.96,"90th_percentile":23481.96,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6165.91,"10th_percentile":5592.92,"90th_percentile":7254.8,"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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":21137.66,"10th_percentile":16424.53,"90th_percentile":24472.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":7125.54,"10th_percentile":7125.54,"90th_percentile":7125.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"20","median_amount":6735.76,"10th_percentile":4405.15,"90th_percentile":8014.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5171.82,"10th_percentile":5171.82,"90th_percentile":5171.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7399.9,"10th_percentile":5879.45,"90th_percentile":9472.91,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5663.1,"maximum":12426.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12426.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8284.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8284.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8706.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5810.47},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5663.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8284.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8284.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6292.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8284.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8284.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8284.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8284.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8284.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8284.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8284.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7247.3},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6476.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8284.34,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":6172.78,"10th_percentile":4296.8,"90th_percentile":10319.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":5537.65,"10th_percentile":4978.14,"90th_percentile":6201.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":20941.65,"10th_percentile":18523.8,"90th_percentile":22434.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17766.12,"10th_percentile":16607.6,"90th_percentile":25364.46,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":5457.95,"10th_percentile":4405.15,"90th_percentile":6165.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"20","median_amount":17858.36,"10th_percentile":14973.55,"90th_percentile":23700.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":6504.81,"10th_percentile":6504.81,"90th_percentile":6504.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"87","median_amount":5856.95,"10th_percentile":4405.15,"90th_percentile":7155.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"20","median_amount":5756.98,"10th_percentile":4405.15,"90th_percentile":7254.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":5604.38,"10th_percentile":4493.25,"90th_percentile":6281.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":4985.83,"10th_percentile":4978.14,"90th_percentile":7653.73,"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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":4534.0,"10th_percentile":4534.0,"90th_percentile":4534.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4987.6,"maximum":11338.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11338.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7558.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7558.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7944.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5117.39},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4987.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7558.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7558.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5541.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7558.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7558.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7558.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7558.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7558.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7558.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7558.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6382.83},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5704.21},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7558.82,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"26","median_amount":9112.65,"10th_percentile":4689.61,"90th_percentile":10319.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"82","median_amount":4909.36,"10th_percentile":3762.8,"90th_percentile":6201.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"30","median_amount":18362.06,"10th_percentile":13550.64,"90th_percentile":26096.51,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"22","median_amount":17502.06,"10th_percentile":15366.03,"90th_percentile":19884.25,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"179","median_amount":4887.19,"10th_percentile":3741.21,"90th_percentile":6158.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"75","median_amount":17611.33,"10th_percentile":14790.03,"90th_percentile":23093.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"16","median_amount":5863.53,"10th_percentile":4188.38,"90th_percentile":7231.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"279","median_amount":4894.55,"10th_percentile":3741.21,"90th_percentile":6222.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4928.98,"10th_percentile":3741.21,"90th_percentile":6158.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"39","median_amount":4881.03,"10th_percentile":3816.03,"90th_percentile":5614.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"23","median_amount":5077.0,"10th_percentile":3807.75,"90th_percentile":5077.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, 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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":4468.0,"10th_percentile":3542.9,"90th_percentile":4534.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7254.8,"10th_percentile":7254.8,"90th_percentile":7254.8,"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."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17927.81,"maximum":32254.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32254.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21502.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21502.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22599.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18394.34},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17927.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21502.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21502.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19919.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21502.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21502.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21502.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21502.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21502.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21502.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21502.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22942.94},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20503.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21502.9,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11429.23,"10th_percentile":11429.23,"90th_percentile":11429.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":20752.3,"10th_percentile":20752.3,"90th_percentile":20752.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":20654.93,"10th_percentile":20654.93,"90th_percentile":20654.93,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18767.09,"10th_percentile":18767.09,"90th_percentile":18767.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9694.2,"maximum":19407.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19407.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12938.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12938.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13598.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9946.47},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9694.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12938.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12938.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10771.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12938.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12938.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12938.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12938.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12938.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12938.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12938.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12406.05},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11087.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12938.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":22496.63,"10th_percentile":22496.63,"90th_percentile":22496.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"810","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7449.31,"maximum":16416.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16416.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10944.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10944.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11502.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7643.16},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7449.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10944.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10944.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8277.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10944.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10944.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10944.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10944.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10944.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10944.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10944.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9533.18},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8519.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10944.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5930.64,"10th_percentile":5930.64,"90th_percentile":5930.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":9534.18,"10th_percentile":9534.18,"90th_percentile":9534.18,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11011.54,"maximum":21295.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21295.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14196.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14196.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14920.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11298.1},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11011.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14196.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14196.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12235.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14196.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14196.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14196.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14196.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14196.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14196.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14196.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14091.92},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12593.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14196.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8890.47,"10th_percentile":8890.47,"90th_percentile":8890.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8569.43,"10th_percentile":8569.43,"90th_percentile":8569.43,"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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":74654.45,"10th_percentile":74654.45,"90th_percentile":74654.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":29508.55,"10th_percentile":29508.55,"90th_percentile":29508.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10268.62,"10th_percentile":10268.62,"90th_percentile":10268.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12451.33,"10th_percentile":12451.33,"90th_percentile":12451.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11191.33,"10th_percentile":11191.33,"90th_percentile":12207.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7223.88,"maximum":14665.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14665.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9777.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9777.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10275.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7411.87},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7223.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9777.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9777.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8026.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9777.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9777.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9777.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9777.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9777.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9777.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9777.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9244.69},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8261.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9777.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":12523.5,"10th_percentile":12523.5,"90th_percentile":12523.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8577.0,"10th_percentile":8577.0,"90th_percentile":8577.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":66473.17,"10th_percentile":66473.17,"90th_percentile":80599.33,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7590.34,"10th_percentile":7590.34,"90th_percentile":8537.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9055.03,"10th_percentile":9055.03,"90th_percentile":9055.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":26976.43,"10th_percentile":26976.43,"90th_percentile":34889.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8414.37,"10th_percentile":8414.37,"90th_percentile":8414.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6063.92,"10th_percentile":6063.92,"90th_percentile":6063.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":160.37,"10th_percentile":160.37,"90th_percentile":160.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12115.99,"maximum":22945.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22945.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15296.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15296.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16076.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12431.28},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12115.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15296.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15296.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13462.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15296.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15296.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15296.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15296.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15296.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15296.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15296.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15505.31},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13856.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15296.84,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11851.74,"10th_percentile":11851.74,"90th_percentile":11851.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Mcc","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16361.55,"maximum":31146.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31146.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20764.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20764.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21823.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16787.32},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16361.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20764.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20764.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18179.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20764.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20764.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20764.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20764.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20764.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20764.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20764.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20938.54},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18712.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20764.65,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17215.81,"10th_percentile":17215.81,"90th_percentile":17215.81,"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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Cc","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7953.39,"maximum":15972.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15972.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10648.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10648.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11191.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8160.36},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7953.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10648.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10648.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8837.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10648.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10648.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10648.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10648.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10648.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10648.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10648.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10178.27},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9096.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10648.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","code_information":[{"code":"816","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5161.37,"maximum":10762.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7541.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5295.68},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5161.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5734.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6605.21},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5902.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7175.14,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":25378.02,"10th_percentile":25378.02,"90th_percentile":25378.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":160.37,"10th_percentile":160.37,"90th_percentile":160.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Mcc","code_information":[{"code":"817","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19843.17,"maximum":33259.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33259.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22172.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22172.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23303.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20359.54},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19843.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22172.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22172.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22047.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22172.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22172.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22172.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22172.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22172.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22172.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22172.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25394.1},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22694.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22172.96,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":31649.12,"10th_percentile":31649.12,"90th_percentile":31649.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9824.41,"10th_percentile":9824.41,"90th_percentile":12766.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9600.6,"10th_percentile":9600.6,"90th_percentile":9600.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Cc","code_information":[{"code":"818","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10081.65,"maximum":17952.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17952.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11968.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11968.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12578.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10344.01},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10081.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11968.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11968.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11201.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11968.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11968.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11968.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11968.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11968.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11968.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11968.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12901.9},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11530.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11968.34,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6635.5,"10th_percentile":6635.5,"90th_percentile":6635.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"819","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6391.05,"maximum":13870.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13870.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9247.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9247.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9718.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6557.36},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6391.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9247.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9247.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7101.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9247.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9247.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9247.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9247.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9247.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9247.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9247.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8178.88},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7309.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9247.16,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1203.01,"10th_percentile":1203.01,"90th_percentile":1203.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","code_information":[{"code":"820","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45570.17,"maximum":82126.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82126.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54750.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54750.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57542.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":46756.03},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45570.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54750.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54750.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50633.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54750.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54750.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54750.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54750.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54750.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54750.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54750.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58317.97},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52117.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54750.68,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Cc","code_information":[{"code":"821","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17472.26,"maximum":32673.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32673.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21782.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21782.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22892.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17926.93},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17472.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21782.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21782.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19413.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21782.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21782.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21782.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21782.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21782.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21782.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21782.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22359.95},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19982.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21782.02,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","code_information":[{"code":"822","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8951.38,"maximum":18563.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18563.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12375.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12375.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13006.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9184.32},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8951.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12375.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12375.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9945.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12375.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12375.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12375.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12375.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12375.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12375.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12375.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11455.44},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10237.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12375.65,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","code_information":[{"code":"823","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36625.83,"maximum":64669.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64669.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43113.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43113.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45311.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":37578.94},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36625.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43113.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43113.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40695.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43113.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43113.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43113.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43113.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43113.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43113.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43113.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46871.55},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41888.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43113.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16347.46,"10th_percentile":16347.46,"90th_percentile":16347.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","code_information":[{"code":"824","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17214.73,"maximum":33041.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33041.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22027.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22027.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23150.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17662.71},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17214.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22027.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22027.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19127.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22027.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22027.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22027.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22027.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22027.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22027.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22027.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22030.39},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19688.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22027.5,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","code_information":[{"code":"825","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9633.14,"maximum":20546.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20546.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13697.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13697.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14396.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9883.83},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9633.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13697.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13697.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10703.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13697.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13697.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13697.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13697.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13697.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13697.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13697.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12327.92},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11017.23},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13697.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","code_information":[{"code":"826","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37377.26,"maximum":65938.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65938.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43958.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43958.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46200.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":38349.92},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37377.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43958.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43958.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41530.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43958.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43958.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43958.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43958.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43958.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43958.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43958.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47833.18},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42747.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43958.72,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","code_information":[{"code":"828","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12545.71,"maximum":25379.60,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25379.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16919.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16919.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17782.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12872.18},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12545.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16919.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16919.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13939.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16919.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16919.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16919.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16919.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16919.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16919.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16919.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16055.25},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14348.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16919.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","code_information":[{"code":"829","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24136.48,"maximum":45238.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45238.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30159.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30159.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31697.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24764.58},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24136.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30159.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30159.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26818.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30159.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30159.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30159.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30159.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30159.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30159.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30159.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30888.42},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27604.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30159.19,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","code_information":[{"code":"830","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11446.75,"maximum":22668.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22668.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15112.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15112.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15883.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11744.62},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11446.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15112.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15112.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12718.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15112.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15112.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15112.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15112.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15112.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15112.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15112.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14648.86},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13091.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15112.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9008.52,"maximum":18543.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18543.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12362.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12362.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12992.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9242.95},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9008.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12362.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12362.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10009.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12362.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12362.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12362.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12362.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12362.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12362.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12362.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11528.57},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10302.86},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12362.01,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4809.62,"10th_percentile":4809.62,"90th_percentile":4809.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4958.67,"10th_percentile":4958.67,"90th_percentile":4958.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5987.67,"10th_percentile":5987.67,"90th_percentile":5987.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Cc","code_information":[{"code":"832","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5849.39,"maximum":11984.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11984.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7989.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7989.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8397.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6001.61},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5849.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7989.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7989.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6499.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7989.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7989.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7989.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7989.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7989.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7989.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7989.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7485.7},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6689.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7989.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"1 through 10","median_amount":6280.24,"10th_percentile":6280.24,"90th_percentile":6280.24,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9624.92,"10th_percentile":9624.92,"90th_percentile":9624.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4068.67,"maximum":9274.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9274.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6183.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6183.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6498.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":4174.54},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4068.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6183.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6183.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":4520.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6183.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6183.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6183.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6183.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6183.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6183.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6183.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5206.84},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4653.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6183.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":6222.22,"10th_percentile":6222.22,"90th_percentile":6222.22,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":15711.67,"10th_percentile":15711.67,"90th_percentile":15711.67,"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":5037.83,"10th_percentile":5037.83,"90th_percentile":5195.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5854.87,"10th_percentile":5854.87,"90th_percentile":5854.87,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2771.79,"10th_percentile":2771.79,"90th_percentile":2771.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4164.96,"10th_percentile":4164.96,"90th_percentile":4164.96,"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."}]}]},{"description":"Acute Leukemia With Mcc","code_information":[{"code":"834","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43261.09,"maximum":77013.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77013.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51342.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51342.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53960.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":44386.87},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43261.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51342.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51342.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48067.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51342.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51342.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51342.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51342.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51342.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51342.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51342.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55362.96},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49476.81},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51342.16,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":38421.17,"10th_percentile":38421.17,"90th_percentile":38421.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Cc","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16717.7,"maximum":30589.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30589.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20392.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20392.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21432.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17152.74},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16717.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20392.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20392.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18575.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20392.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20392.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20392.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20392.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20392.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20392.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20392.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21394.31},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19119.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20392.79,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3272.16,"10th_percentile":3272.16,"90th_percentile":3272.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia Without Cc/Mcc","code_information":[{"code":"836","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9946.24,"maximum":18774.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18774.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12516.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12516.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13154.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10205.07},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9946.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12516.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12516.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11051.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12516.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12516.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12516.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12516.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12516.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12516.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12516.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12728.6},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11375.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12516.57,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","code_information":[{"code":"838","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15874.69,"maximum":30611.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30611.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20407.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20407.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21448.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16287.79},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15874.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20407.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20407.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17638.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20407.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20407.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20407.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20407.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20407.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20407.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20407.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20315.48},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18155.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20407.34,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"839","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10725.85,"maximum":21835.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21835.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14556.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14556.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15299.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11004.96},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10725.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14556.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14556.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11917.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14556.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14556.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14556.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14556.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14556.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14556.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14556.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13726.3},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12266.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14556.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11424.04,"10th_percentile":11424.04,"90th_percentile":11424.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Mcc","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24964.61,"maximum":46260.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46260.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30840.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30840.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32413.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25614.26},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24964.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30840.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30840.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27738.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30840.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30840.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30840.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30840.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30840.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30840.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30840.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31948.22},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28551.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30840.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":26309.96,"10th_percentile":26309.96,"90th_percentile":26309.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":36582.39,"10th_percentile":36582.39,"90th_percentile":36582.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24928.41,"10th_percentile":24928.41,"90th_percentile":24928.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Cc","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12272.53,"maximum":24392.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24392.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16261.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16261.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17090.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12591.9},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12272.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16261.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16261.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13636.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16261.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16261.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16261.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16261.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16261.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16261.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16261.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15705.65},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14035.84},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16261.48,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":13058.16,"10th_percentile":13058.16,"90th_percentile":13058.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19232.84,"10th_percentile":19232.84,"90th_percentile":19232.84,"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":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8232.83,"maximum":15923.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15923.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10615.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10615.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11156.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8447.07},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8232.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10615.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10615.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9147.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10615.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10615.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10615.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10615.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10615.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10615.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10615.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10535.88},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9415.71},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10615.48,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":9090.3,"10th_percentile":9090.3,"90th_percentile":9090.3,"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":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14817.99,"maximum":29348.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29348.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19565.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19565.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20563.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15203.6},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14817.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19565.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19565.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16464.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19565.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19565.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19565.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19565.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19565.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19565.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19565.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18963.18},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16947.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19565.44,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14826.19,"10th_percentile":14826.19,"90th_percentile":14826.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","code_information":[{"code":"844","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9354.49,"maximum":18746.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18746.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12497.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12497.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13134.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9597.92},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9354.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12497.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12497.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10393.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12497.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12497.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12497.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12497.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12497.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12497.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12497.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11971.32},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10698.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12497.48,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":16819.37,"10th_percentile":16819.37,"90th_percentile":16819.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","code_information":[{"code":"845","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6549.16,"maximum":13757.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13757.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9171.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9171.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9639.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6719.59},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6549.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9171.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9171.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7276.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9171.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9171.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9171.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9171.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9171.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9171.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9171.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8381.22},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7490.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9171.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","code_information":[{"code":"846","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19987.97,"maximum":37499.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37499.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24999.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24999.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26274.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20508.11},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19987.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24999.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24999.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22208.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24999.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24999.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24999.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24999.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24999.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24999.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24999.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25579.41},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22859.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24999.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"848","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6409.83,"maximum":13727.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13727.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9151.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9151.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9618.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6576.64},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6409.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9151.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9151.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7122.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9151.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9151.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9151.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9151.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9151.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9151.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9151.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8202.92},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7330.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9151.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Radiotherapy","code_information":[{"code":"849","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20906.12,"maximum":39095.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39095.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26063.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26063.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27392.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21450.16},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20906.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26063.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26063.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23229.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26063.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26063.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26063.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26063.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26063.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26063.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26063.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26754.41},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23909.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26063.34,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Other Procedures","code_information":[{"code":"850","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":72100.25,"maximum":120239.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":120239.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80159.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80159.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":84247.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":73976.5},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":72100.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80159.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80159.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":80111.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80159.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80159.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80159.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80159.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80159.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80159.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80159.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92269.59},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82459.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80159.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39148.59,"maximum":69494.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69494.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48692.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":40167.35},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39148.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43498.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46329.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50100.03},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44773.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46329.86,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":60929.0,"10th_percentile":60929.0,"90th_percentile":60929.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":35183.18,"10th_percentile":16184.14,"90th_percentile":35989.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38052.74,"10th_percentile":37748.94,"90th_percentile":39781.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38164.46,"10th_percentile":38164.46,"90th_percentile":38164.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":61125.29,"10th_percentile":56125.44,"90th_percentile":301589.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":132337.22,"10th_percentile":132337.22,"90th_percentile":132337.22,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":31246.28,"10th_percentile":23994.3,"90th_percentile":43663.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40674.14,"10th_percentile":40674.14,"90th_percentile":56016.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39453.92,"10th_percentile":39453.92,"90th_percentile":39453.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":62131.86,"10th_percentile":59076.23,"90th_percentile":134990.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":67855.51,"10th_percentile":67855.51,"90th_percentile":67855.51},{"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":39894.16,"10th_percentile":39894.16,"90th_percentile":39894.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":18837.39,"10th_percentile":7971.87,"90th_percentile":34684.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39418.31,"10th_percentile":35369.66,"90th_percentile":106963.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39439.46,"10th_percentile":39439.46,"90th_percentile":39536.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23183.19,"10th_percentile":23183.19,"90th_percentile":23183.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":38048.13,"10th_percentile":4988.29,"90th_percentile":153134.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39893.3,"10th_percentile":39893.3,"90th_percentile":39893.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":51611.95,"10th_percentile":51611.95,"90th_percentile":51611.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":49748.25,"10th_percentile":49748.25,"90th_percentile":49748.25,"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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37900.66,"10th_percentile":14387.36,"90th_percentile":55242.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":19791.07,"10th_percentile":19791.07,"90th_percentile":19791.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8976.49,"10th_percentile":8976.49,"90th_percentile":14475.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14857.17,"10th_percentile":14857.17,"90th_percentile":14857.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":63413.19,"10th_percentile":63413.19,"90th_percentile":64941.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":19681.12,"10th_percentile":19681.12,"90th_percentile":22546.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"11","median_amount":42128.12,"10th_percentile":31327.0,"90th_percentile":68922.42,"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":"1 through 10","median_amount":21135.03,"10th_percentile":21135.03,"90th_percentile":21135.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10309.63,"10th_percentile":6212.71,"90th_percentile":28385.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16365.26,"10th_percentile":16365.26,"90th_percentile":16365.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":13213.44,"10th_percentile":13213.44,"90th_percentile":13213.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":744.9,"10th_percentile":744.9,"90th_percentile":744.9,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12810.07,"10th_percentile":12810.07,"90th_percentile":12810.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"855","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12723.39,"maximum":22562.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22562.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15041.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15041.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15808.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13054.49},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12723.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15041.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15041.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14137.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15041.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15041.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15041.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15041.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15041.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15041.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15041.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16282.63},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14551.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15041.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","code_information":[{"code":"856","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35311.61,"maximum":64177.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64177.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42784.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42784.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44967.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":36230.52},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35311.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42784.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42784.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39235.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42784.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42784.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42784.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42784.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42784.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42784.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42784.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45189.69},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40385.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42784.97,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":38201.65,"10th_percentile":38201.65,"90th_percentile":38201.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9812.66,"10th_percentile":9812.66,"90th_percentile":9812.66,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":31503.75,"10th_percentile":31503.75,"90th_percentile":31503.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34163.04,"10th_percentile":34163.04,"90th_percentile":34163.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","code_information":[{"code":"857","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17055.06,"maximum":31348.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31348.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20899.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20899.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21965.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17498.88},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17055.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20899.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20899.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18950.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20899.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20899.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20899.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20899.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20899.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20899.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20899.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21826.04},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19505.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20899.2,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":13702.66,"10th_percentile":13702.66,"90th_percentile":13702.66,"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":"0","additional_payer_notes":"No services performed during 15-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":17782.15,"10th_percentile":17782.15,"90th_percentile":17782.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"858","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10084.78,"maximum":21139.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21139.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14093.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14093.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14811.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10347.22},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10084.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14093.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14093.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11205.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14093.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14093.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14093.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14093.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14093.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14093.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14093.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12905.9},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11533.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14093.09,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14391.4,"maximum":27014.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27014.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18928.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14765.91},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14391.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15990.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18009.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18417.26},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16459.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18009.83,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":6347.6,"10th_percentile":6347.6,"90th_percentile":6347.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20494.43,"10th_percentile":20494.43,"90th_percentile":20494.43,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":14606.78,"10th_percentile":14606.78,"90th_percentile":19896.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15607.57,"10th_percentile":15607.57,"90th_percentile":15607.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20787.77,"10th_percentile":20787.77,"90th_percentile":20787.77,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8680.68,"10th_percentile":8680.68,"90th_percentile":8680.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15710.72,"10th_percentile":15710.72,"90th_percentile":15710.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7826.59,"maximum":15752.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15752.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10501.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10501.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11037.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8030.26},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7826.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10501.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10501.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8696.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10501.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10501.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10501.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10501.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10501.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10501.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10501.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10016.0},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8951.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10501.83,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26890.11,"10th_percentile":26890.11,"90th_percentile":26890.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":8674.92,"10th_percentile":8674.92,"90th_percentile":8674.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":23008.94,"10th_percentile":23008.94,"90th_percentile":23008.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":7028.2,"maximum":14249.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14249.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9984.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7211.09},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7028.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7809.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8994.26},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8038.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9499.91,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7081.6,"10th_percentile":7081.6,"90th_percentile":7081.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8433.34,"10th_percentile":8433.34,"90th_percentile":8433.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14095.41,"10th_percentile":14095.41,"90th_percentile":14095.41,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness With Mcc","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11552.42,"maximum":22577.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22577.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15051.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15051.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15818.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11853.04},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11552.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15051.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15051.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12836.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15051.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15051.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15051.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15051.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15051.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15051.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15051.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14784.09},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13212.26},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15051.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":45422.46,"10th_percentile":45422.46,"90th_percentile":45422.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6924.87,"maximum":14003.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14003.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9335.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9335.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9811.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7105.08},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6924.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9335.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9335.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7694.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9335.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9335.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9335.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9335.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9335.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9335.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9335.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8862.04},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7919.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9335.35,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":22024.01,"10th_percentile":22024.01,"90th_percentile":22024.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Mcc","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16783.45,"maximum":30690.10,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30690.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20460.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20460.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21503.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17220.2},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16783.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20460.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20460.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18648.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20460.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20460.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20460.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20460.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20460.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20460.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20460.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21478.45},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19194.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20460.07,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15846.34,"10th_percentile":15846.34,"90th_percentile":15846.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Cc","code_information":[{"code":"868","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8218.74,"maximum":16205.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16205.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10803.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10803.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11354.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8432.61},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8218.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10803.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10803.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9131.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10803.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10803.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10803.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10803.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10803.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10803.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10803.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10517.85},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9399.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10803.68,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":16982.13,"10th_percentile":16982.13,"90th_percentile":16982.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5631.79,"maximum":12095.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12095.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8063.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8063.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8474.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5778.35},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5631.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8063.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8063.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6257.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8063.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8063.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8063.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8063.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8063.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8063.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8063.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7207.23},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6440.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8063.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":54451.1,"maximum":96404.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96404.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64269.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64269.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":67547.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":55868.07},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54451.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64269.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64269.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":60501.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64269.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64269.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64269.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64269.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64269.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64269.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64269.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69683.26},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62274.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64269.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":62164.66,"10th_percentile":62164.66,"90th_percentile":62164.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53448.04,"10th_percentile":53448.04,"90th_percentile":53448.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":114278.56,"10th_percentile":114278.56,"90th_percentile":114278.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":295785.84,"10th_percentile":295785.84,"90th_percentile":295785.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":53065.33,"10th_percentile":29642.39,"90th_percentile":69316.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":55635.93,"10th_percentile":55635.93,"90th_percentile":55635.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":227571.73,"10th_percentile":227571.73,"90th_percentile":227571.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":39565.1,"10th_percentile":39565.1,"90th_percentile":39565.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":19049.09,"10th_percentile":18477.67,"90th_percentile":133228.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32303.76,"10th_percentile":32303.76,"90th_percentile":32303.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53828.81,"10th_percentile":53594.72,"90th_percentile":54550.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":75871.26,"10th_percentile":75871.26,"90th_percentile":75871.26,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53142.08,"10th_percentile":53142.08,"90th_percentile":53606.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"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":15359.65,"maximum":28634.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28634.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19089.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19089.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20063.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15759.35},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15359.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19089.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19089.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17066.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19089.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19089.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19089.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19089.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19089.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19089.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19089.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19656.36},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17566.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19089.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":20554.59,"10th_percentile":20554.59,"90th_percentile":24878.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"38","median_amount":13892.18,"10th_percentile":8725.63,"90th_percentile":19031.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"31","median_amount":15025.99,"10th_percentile":8030.62,"90th_percentile":16253.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16253.82,"10th_percentile":14578.16,"90th_percentile":18118.61,"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] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"11","median_amount":30280.79,"10th_percentile":20726.23,"90th_percentile":85567.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":45908.31,"10th_percentile":20044.54,"90th_percentile":72771.67,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":12699.02,"10th_percentile":8369.25,"90th_percentile":19001.91,"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":"13","median_amount":16235.63,"10th_percentile":14477.64,"90th_percentile":16585.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16088.06,"10th_percentile":16055.12,"90th_percentile":16174.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"29","median_amount":38775.34,"10th_percentile":16467.47,"90th_percentile":88469.61,"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":12441.06,"10th_percentile":12441.06,"90th_percentile":12441.06},{"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":15417.99,"10th_percentile":10127.46,"90th_percentile":15959.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"47","median_amount":10152.06,"10th_percentile":2636.43,"90th_percentile":18476.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14620.19,"10th_percentile":14620.19,"90th_percentile":14620.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"84","median_amount":12116.24,"10th_percentile":6932.33,"90th_percentile":16230.79,"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":"1 through 10","median_amount":16113.66,"10th_percentile":11132.06,"90th_percentile":16676.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14909.63,"10th_percentile":14909.63,"90th_percentile":17132.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"35","median_amount":11117.82,"10th_percentile":8445.34,"90th_percentile":16757.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":14611.44,"10th_percentile":14578.16,"90th_percentile":16467.47,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":10798.08,"10th_percentile":1641.29,"90th_percentile":15744.55,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":19622.71,"10th_percentile":7702.76,"90th_percentile":20209.35,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":17564.72,"10th_percentile":17376.61,"90th_percentile":26801.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"40","median_amount":14410.05,"10th_percentile":6896.72,"90th_percentile":18109.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8070.02,"maximum":16099.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16099.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10732.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10732.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11280.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8280.02},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8070.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10732.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10732.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8966.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10732.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10732.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10732.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10732.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10732.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10732.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10732.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10327.53},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9229.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10732.76,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":13808.55,"10th_percentile":13808.55,"90th_percentile":13808.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8693.71,"10th_percentile":7784.03,"90th_percentile":10085.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9021.59,"10th_percentile":7261.59,"90th_percentile":9518.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":30303.84,"10th_percentile":25902.57,"90th_percentile":39097.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26218.06,"10th_percentile":19801.13,"90th_percentile":74550.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"20","median_amount":7358.69,"10th_percentile":5999.79,"90th_percentile":9756.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in 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":8702.02,"10th_percentile":8501.67,"90th_percentile":9189.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8913.54,"10th_percentile":8913.54,"90th_percentile":8913.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"19","median_amount":25672.3,"10th_percentile":16193.99,"90th_percentile":43789.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9434.93,"10th_percentile":9434.93,"90th_percentile":9434.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6236.2,"10th_percentile":730.29,"90th_percentile":10239.01,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7164.02,"10th_percentile":7164.02,"90th_percentile":7164.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":7190.22,"10th_percentile":6445.31,"90th_percentile":7800.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":7412.94,"10th_percentile":4390.69,"90th_percentile":9650.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9055.21,"10th_percentile":9055.21,"90th_percentile":9055.21,"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":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7697.38,"10th_percentile":7697.38,"90th_percentile":9114.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":6872.19,"10th_percentile":6487.01,"90th_percentile":10250.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":9192.59,"10th_percentile":9192.59,"90th_percentile":9229.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":7198.89,"10th_percentile":5754.12,"90th_percentile":9017.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Principal Diagnosis Of Mental Illness","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30756.87,"maximum":54852.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54852.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36568.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36568.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38432.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31557.25},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30756.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36568.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36568.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34174.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36568.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36568.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36568.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36568.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36568.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36568.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36568.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39360.8},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35175.99},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36568.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31536.32,"10th_percentile":31536.32,"90th_percentile":31536.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":28874.85,"10th_percentile":28874.85,"90th_percentile":28874.85,"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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":10484.25,"10th_percentile":10484.25,"90th_percentile":10484.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8444.2,"10th_percentile":8444.2,"90th_percentile":8444.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5063.96,"10th_percentile":5063.96,"90th_percentile":5063.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":36772.68,"10th_percentile":36772.68,"90th_percentile":36772.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7155.0,"maximum":14975.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14975.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9983.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9983.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10492.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7341.19},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7155.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9983.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9983.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7950.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9983.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9983.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9983.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9983.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9983.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9983.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9983.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9156.54},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8183.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9983.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":3452.69,"10th_percentile":3452.69,"90th_percentile":3452.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5349.0,"10th_percentile":5349.0,"90th_percentile":5349.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in 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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":7245.55,"10th_percentile":5056.05,"90th_percentile":13320.27,"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":1119.99,"10th_percentile":1119.99,"90th_percentile":1119.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neuroses Except Depressive","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7529.15,"maximum":16787.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16787.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11191.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11191.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11762.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7725.08},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7529.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11191.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11191.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8365.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11191.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11191.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11191.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11191.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11191.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11191.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11191.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9635.35},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8610.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11191.9,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1464.84,"10th_percentile":1464.84,"90th_percentile":1464.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":13853.13,"10th_percentile":13853.13,"90th_percentile":13853.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20470.81,"10th_percentile":20470.81,"90th_percentile":20470.81,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2532.98,"10th_percentile":2532.98,"90th_percentile":4053.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":17123.25,"10th_percentile":17123.25,"90th_percentile":17123.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3623.68,"10th_percentile":3623.68,"90th_percentile":3623.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2531.98,"10th_percentile":2531.98,"90th_percentile":5262.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Personality And Impulse Control","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14530.73,"maximum":28959.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28959.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19306.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19306.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20290.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14908.86},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14530.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19306.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19306.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16145.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19306.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19306.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19306.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19306.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19306.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19306.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19306.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18595.56},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16618.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19306.32,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":15704.55,"10th_percentile":15704.55,"90th_percentile":15704.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7741.52,"10th_percentile":7741.52,"90th_percentile":7741.52,"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":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13072.49,"maximum":24085.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24085.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16056.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16056.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16875.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13412.67},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13072.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16056.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16056.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14524.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16056.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16056.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16056.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16056.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16056.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16056.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16056.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16729.39},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14950.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16056.92,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":12971.05,"10th_percentile":12971.05,"90th_percentile":12971.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5708.35,"10th_percentile":5708.35,"90th_percentile":5708.35,"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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7661.47,"10th_percentile":7661.47,"90th_percentile":7661.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13968.67,"10th_percentile":13968.67,"90th_percentile":13968.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11032.68,"maximum":21192.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21192.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14128.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14128.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14849.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11319.78},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11032.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14128.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14128.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12258.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14128.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14128.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14128.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14128.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14128.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14128.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14128.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14118.96},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12617.84},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14128.55,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"20","median_amount":16874.2,"10th_percentile":8137.74,"90th_percentile":18309.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"69","median_amount":6329.95,"10th_percentile":2734.8,"90th_percentile":15464.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9949.27,"10th_percentile":4391.08,"90th_percentile":30669.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9786.49,"10th_percentile":6275.57,"90th_percentile":95376.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"14","median_amount":12691.41,"10th_percentile":8007.03,"90th_percentile":26328.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":16570.45,"10th_percentile":5915.2,"90th_percentile":29657.44,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7936.56,"10th_percentile":4922.3,"90th_percentile":18990.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6789.6,"10th_percentile":6789.6,"90th_percentile":6789.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":5367.67,"10th_percentile":3361.37,"90th_percentile":15578.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"56","median_amount":16568.29,"10th_percentile":7994.34,"90th_percentile":36948.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":4200.0,"10th_percentile":2800.0,"90th_percentile":16100.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11767.09,"10th_percentile":6616.57,"90th_percentile":39863.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16099.88,"10th_percentile":16099.88,"90th_percentile":16099.88,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":7595.94,"10th_percentile":3797.97,"90th_percentile":19184.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"18","median_amount":7727.92,"10th_percentile":5547.71,"90th_percentile":24749.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9095.38,"10th_percentile":5399.87,"90th_percentile":22793.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"78","median_amount":7595.94,"10th_percentile":3862.68,"90th_percentile":17839.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7174.77,"10th_percentile":5784.87,"90th_percentile":21168.11,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"26","median_amount":6456.55,"10th_percentile":3939.93,"90th_percentile":13133.1,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"12","median_amount":5850.0,"10th_percentile":2480.0,"90th_percentile":7150.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, 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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":3250.0,"10th_percentile":3250.0,"90th_percentile":3250.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, 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":"18","median_amount":3900.0,"10th_percentile":1950.0,"90th_percentile":18200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10277.91,"10th_percentile":5180.01,"90th_percentile":50765.36,"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":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14061.09,"maximum":30446.00,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30446.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20297.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20297.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21332.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14427.0},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14061.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20297.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20297.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15623.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20297.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20297.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20297.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20297.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20297.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20297.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20297.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17994.54},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16081.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20297.33,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Mental Disorder Diagnoses","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9309.09,"maximum":16748.30,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16748.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11165.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11165.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11734.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9551.34},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9309.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11165.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11165.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10343.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11165.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11165.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11165.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11165.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11165.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11165.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11165.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11913.22},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10646.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11165.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4885.06,"maximum":10556.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10556.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7037.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7037.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7396.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5012.18},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4885.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7037.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7037.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5427.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7037.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7037.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7037.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7037.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7037.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7037.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7037.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6251.61},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5586.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7037.86,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3167.23,"10th_percentile":2610.83,"90th_percentile":3486.41,"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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5007.96,"10th_percentile":5007.96,"90th_percentile":5993.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6165.3,"10th_percentile":6165.3,"90th_percentile":6165.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4028.5,"10th_percentile":4028.5,"90th_percentile":4028.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","code_information":[{"code":"895","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11333.25,"maximum":21449.20,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21449.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14299.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14299.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15028.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11628.17},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11333.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14299.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14299.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12592.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14299.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14299.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14299.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14299.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14299.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14299.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14299.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14503.61},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12961.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14299.47,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13938.98,"maximum":25942.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25942.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17295.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17295.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18177.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14301.71},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13938.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17295.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17295.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15487.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17295.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17295.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17295.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17295.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17295.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17295.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17295.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17838.27},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15941.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17295.22,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9657.25,"10th_percentile":9657.25,"90th_percentile":9657.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":20560.8,"10th_percentile":20560.8,"90th_percentile":20560.8,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":186.67,"10th_percentile":186.67,"90th_percentile":186.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11355.33,"10th_percentile":8196.23,"90th_percentile":22721.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":41725.75,"10th_percentile":41725.75,"90th_percentile":41725.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9603.96,"10th_percentile":9603.96,"90th_percentile":9603.96,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13403.31,"10th_percentile":13403.31,"90th_percentile":13403.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6905.31,"maximum":14183.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14183.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9455.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9455.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9937.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7085.0},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6905.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9455.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9455.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7672.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9455.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9455.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9455.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9455.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9455.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9455.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9455.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8837.0},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7897.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9455.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":26452.68,"10th_percentile":26452.68,"90th_percentile":27739.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35283.45,"10th_percentile":19503.32,"90th_percentile":47516.08,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5252.36,"10th_percentile":4063.07,"90th_percentile":7367.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8565.85,"10th_percentile":8565.85,"90th_percentile":8565.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7776.24,"10th_percentile":7776.24,"90th_percentile":7776.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":18371.88,"10th_percentile":13811.99,"90th_percentile":38053.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8664.15,"10th_percentile":8664.15,"90th_percentile":8664.15,"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":"[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":5209.05,"10th_percentile":4040.72,"90th_percentile":8336.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7865.78,"10th_percentile":7865.78,"90th_percentile":8394.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":5481.91,"10th_percentile":650.56,"90th_percentile":7238.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2002.54,"10th_percentile":2002.54,"90th_percentile":5013.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":7069.6,"10th_percentile":7069.6,"90th_percentile":7069.6,"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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6033.61,"10th_percentile":6033.61,"90th_percentile":6033.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34676.81,"maximum":59375.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59375.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39583.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39583.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41602.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":35579.2},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34676.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39583.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39583.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38529.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39583.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39583.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39583.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39583.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39583.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39583.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39583.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44377.31},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39659.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39583.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14851.65,"maximum":28253.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28253.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18835.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18835.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19795.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15238.13},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14851.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18835.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18835.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16501.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18835.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18835.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18835.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18835.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18835.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18835.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18835.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19006.26},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16985.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18835.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries Without Cc/Mcc","code_information":[{"code":"903","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9541.56,"maximum":18094.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18094.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12062.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12062.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12678.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9789.86},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9541.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12062.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12062.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10601.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12062.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12062.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12062.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12062.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12062.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12062.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12062.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12210.72},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10912.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12062.89,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries With Cc/Mcc","code_information":[{"code":"904","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30220.69,"maximum":52236.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52236.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34824.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34824.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36600.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31007.12},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30220.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34824.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34824.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33578.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34824.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34824.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34824.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34824.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34824.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34824.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34824.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38674.64},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34562.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34824.19,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries Without Cc/Mcc","code_information":[{"code":"905","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12900.29,"maximum":22373.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22373.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14915.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14915.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15676.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13235.99},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12900.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14915.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14915.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14333.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14915.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14915.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14915.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14915.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14915.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14915.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14915.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16509.02},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14753.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14915.9,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Procedures For Injuries","code_information":[{"code":"906","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17082.45,"maximum":28932.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28932.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19288.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19288.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20271.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17526.99},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17082.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19288.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19288.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18980.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19288.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19288.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19288.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19288.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19288.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19288.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19288.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21861.1},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19536.84},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19288.14,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Mcc","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31180.33,"maximum":54502.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54502.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36335.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36335.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38188.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31991.73},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31180.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36335.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36335.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34644.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36335.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36335.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36335.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36335.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36335.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36335.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36335.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39902.72},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35660.29},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36335.25,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":70357.08,"10th_percentile":70357.08,"90th_percentile":70357.08,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":15237.49,"10th_percentile":15237.49,"90th_percentile":15237.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":69040.91,"10th_percentile":69040.91,"90th_percentile":69040.91,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9578.56,"10th_percentile":9578.56,"90th_percentile":9578.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15787.81,"maximum":29353.60,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29353.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19569.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19569.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20567.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16198.65},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15787.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19569.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19569.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17542.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19569.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19569.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19569.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19569.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19569.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19569.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19569.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20204.29},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18056.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19569.07,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":13796.15,"10th_percentile":13796.15,"90th_percentile":13796.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16556.44,"10th_percentile":16556.44,"90th_percentile":16556.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8036.64,"10th_percentile":8036.64,"90th_percentile":8036.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9926.67,"maximum":20045.90,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20045.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13363.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13363.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14045.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10184.99},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9926.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13363.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13363.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11029.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13363.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13363.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13363.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13363.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13363.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13363.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13363.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12703.56},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11352.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13363.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury With Mcc","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12666.25,"maximum":24435.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24435.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16290.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16290.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17121.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12995.86},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12666.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16290.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16290.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14073.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16290.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16290.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16290.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16290.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16290.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16290.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16290.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16209.51},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14486.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16290.57,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury Without Mcc","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7172.22,"maximum":14219.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14219.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9479.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9479.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9963.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7358.86},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7172.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9479.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9479.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7969.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9479.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9479.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9479.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9479.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9479.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9479.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9479.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9178.58},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8202.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9479.91,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions With Mcc","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13602.4,"maximum":25076.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25076.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16717.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16717.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17570.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13956.38},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13602.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16717.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16717.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15113.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16717.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16717.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16717.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16717.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16717.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16717.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16717.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17407.54},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15556.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16717.89,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7569.82,"10th_percentile":7569.82,"90th_percentile":7569.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions Without Mcc","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5197.37,"maximum":11230.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11230.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7486.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7486.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7868.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5332.62},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5197.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7486.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7486.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5774.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7486.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7486.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7486.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7486.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7486.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7486.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7486.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6651.29},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5944.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7486.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3592.89,"10th_percentile":3592.89,"90th_percentile":3592.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":6006.9,"10th_percentile":6006.9,"90th_percentile":6006.9,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12833.76,"maximum":23533.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23533.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15688.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15688.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16488.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13167.73},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12833.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15688.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15688.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14259.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15688.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15688.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15688.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15688.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15688.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15688.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15688.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16423.87},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14677.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15688.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":75012.82,"10th_percentile":75012.82,"90th_percentile":75012.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":28193.49,"10th_percentile":28193.49,"90th_percentile":28193.49,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":65066.69,"10th_percentile":65066.69,"90th_percentile":65066.69,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8111.55,"10th_percentile":6368.27,"90th_percentile":9593.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":52129.54,"10th_percentile":52129.54,"90th_percentile":52129.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6368.27,"10th_percentile":5222.29,"90th_percentile":9589.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":7821.3,"10th_percentile":7821.3,"90th_percentile":7821.3,"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":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12641.05,"10th_percentile":12641.05,"90th_percentile":12641.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6351.37,"10th_percentile":6351.37,"90th_percentile":6351.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":12422.84,"10th_percentile":12422.84,"90th_percentile":12422.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9591.62,"10th_percentile":9591.62,"90th_percentile":9591.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6922.53,"maximum":13832.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13832.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9221.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9221.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9692.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7102.67},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6922.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9221.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9221.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7691.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9221.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9221.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9221.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9221.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9221.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9221.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9221.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8859.03},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7917.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9221.71,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":10804.55,"10th_percentile":10804.55,"90th_percentile":12068.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6329.95,"10th_percentile":4358.08,"90th_percentile":6392.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":14546.62,"10th_percentile":14546.62,"90th_percentile":19114.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6329.95,"10th_percentile":6329.95,"90th_percentile":8111.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6555.74,"10th_percentile":6555.74,"90th_percentile":6555.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7804.09,"10th_percentile":7804.09,"90th_percentile":7804.09,"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":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":18489.79,"10th_percentile":12372.38,"90th_percentile":25521.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5072.8,"10th_percentile":4856.71,"90th_percentile":6661.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":451.51,"10th_percentile":451.51,"90th_percentile":451.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4283.72,"10th_percentile":4283.72,"90th_percentile":5516.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4687.51,"10th_percentile":4687.51,"90th_percentile":4687.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7807.96,"10th_percentile":7807.96,"90th_percentile":7807.96,"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."}]}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14272.43,"maximum":27111.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27111.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18074.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18074.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18996.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14643.83},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14272.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18074.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18074.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15858.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18074.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18074.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18074.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18074.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18074.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18074.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18074.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18265.0},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16323.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18074.38,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":31979.91,"10th_percentile":31979.91,"90th_percentile":31979.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7152.71,"10th_percentile":7152.71,"90th_percentile":7152.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15147.2,"10th_percentile":15147.2,"90th_percentile":15147.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7951.04,"maximum":15812.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15812.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10541.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10541.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11079.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8157.95},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7951.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10541.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10541.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8834.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10541.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10541.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10541.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10541.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10541.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10541.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10541.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10175.27},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9093.44},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10541.83,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9630.35,"10th_percentile":9630.35,"90th_percentile":9630.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8904.37,"10th_percentile":8904.37,"90th_percentile":8904.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4885.86,"10th_percentile":4885.86,"90th_percentile":4885.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6347.73,"10th_percentile":6347.73,"90th_percentile":6347.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5382.1,"maximum":11531.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11531.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7687.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7687.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8080.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5522.16},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5382.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7687.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7687.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5980.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7687.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7687.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7687.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7687.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7687.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7687.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7687.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6887.69},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6155.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7687.92,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6294.29,"10th_percentile":6294.29,"90th_percentile":6294.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13221.99,"maximum":26001.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26001.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17334.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17334.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18218.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13566.07},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13221.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17334.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17334.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14691.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17334.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17334.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17334.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17334.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17334.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17334.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17334.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16920.72},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15121.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17334.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":20028.48,"10th_percentile":20028.48,"90th_percentile":20028.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":123627.81,"10th_percentile":123627.81,"90th_percentile":123627.81,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":50334.12,"10th_percentile":50334.12,"90th_percentile":50334.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13944.55,"10th_percentile":13944.55,"90th_percentile":13944.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":49501.32,"10th_percentile":49501.32,"90th_percentile":49501.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13832.23,"10th_percentile":13832.23,"90th_percentile":13832.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7982.35,"maximum":16022.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16022.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10681.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10681.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11226.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8190.07},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7982.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10681.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10681.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8869.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10681.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10681.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10681.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10681.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10681.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10681.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10681.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10215.34},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9129.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10681.85,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":45556.03,"10th_percentile":45556.03,"90th_percentile":45556.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6209.3,"10th_percentile":6209.3,"90th_percentile":6209.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","code_information":[{"code":"927","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":185687.13,"maximum":293315.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":293315.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195543.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195543.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":205516.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":190519.23},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":185687.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195543.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195543.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":206319.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195543.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195543.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195543.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195543.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195543.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195543.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195543.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":237631.29},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":212366.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":195543.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","code_information":[{"code":"928","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52275.09,"maximum":99962.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99962.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66641.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66641.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":70040.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":53635.43},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52275.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66641.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66641.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58083.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66641.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66641.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66641.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66641.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66641.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66641.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66641.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66898.53},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59785.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66641.83,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","code_information":[{"code":"716","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11108.6,"maximum":22204.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22204.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14803.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14803.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15558.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11397.68},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11108.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14803.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14803.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12342.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14803.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14803.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14803.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14803.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14803.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14803.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14803.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14216.13},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12704.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14803.16,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","code_information":[{"code":"717","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14522.9,"maximum":27925.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27925.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18617.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18617.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19566.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14900.83},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14522.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18617.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18617.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16136.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18617.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18617.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18617.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18617.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18617.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18617.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18617.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18585.54},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16609.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18617.16,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","code_information":[{"code":"718","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9641.75,"maximum":20460.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20460.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13640.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13640.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14335.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9892.66},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9641.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13640.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13640.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10713.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13640.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13640.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13640.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13640.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13640.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13640.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13640.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12338.94},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11027.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13640.32,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Mcc","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13531.96,"maximum":26823.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26823.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17882.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17882.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18794.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13884.1},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13531.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17882.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17882.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15035.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17882.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17882.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17882.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17882.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17882.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17882.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17882.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17317.39},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15476.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17882.55,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Cc","code_information":[{"code":"723","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8789.35,"maximum":17727.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17727.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11818.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11818.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12421.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9018.08},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8789.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11818.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11818.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9765.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11818.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11818.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11818.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11818.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11818.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11818.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11818.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11248.09},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10052.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11818.32,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System Without Cc/Mcc","code_information":[{"code":"724","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5703.02,"maximum":11085.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11085.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7767.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5851.43},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5703.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6336.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7298.39},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6522.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy With Mcc","code_information":[{"code":"725","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9886.75,"maximum":18102.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18102.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12068.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12068.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12683.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10144.03},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9886.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12068.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12068.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10985.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12068.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12068.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12068.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12068.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12068.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12068.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12068.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12652.47},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11307.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12068.35,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy Without Mcc","code_information":[{"code":"726","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5825.91,"maximum":11990.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11990.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7993.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7993.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8401.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5977.52},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5825.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7993.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7993.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6473.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7993.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7993.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7993.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7993.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7993.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7993.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7993.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7455.65},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6662.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7993.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":6934.22,"10th_percentile":6934.22,"90th_percentile":6934.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System With Mcc","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11500.75,"maximum":22367.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22367.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14911.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14911.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15671.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11800.04},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11500.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14911.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14911.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12778.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14911.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14911.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14911.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14911.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14911.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14911.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14911.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14717.98},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13153.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14911.35,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System Without Mcc","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6395.74,"maximum":13206.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13206.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8804.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8804.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9253.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6562.18},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6395.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8804.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8804.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7106.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8804.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8804.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8804.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8804.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8804.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8804.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8804.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8184.89},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7314.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8804.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1031.0,"10th_percentile":1031.0,"90th_percentile":1031.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in 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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":29512.08,"10th_percentile":29512.08,"90th_percentile":29512.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses With Cc/Mcc","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8616.37,"maximum":16581.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16581.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11054.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11054.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11618.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8840.59},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8616.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11054.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11054.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9573.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11054.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11054.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11054.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11054.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11054.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11054.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11054.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11026.71},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9854.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11054.61,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5141.91,"10th_percentile":5141.91,"90th_percentile":5141.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1009.0,"10th_percentile":1009.0,"90th_percentile":1009.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses Without Cc/Mcc","code_information":[{"code":"730","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4750.43,"maximum":11308.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11308.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7538.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7538.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7923.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":4874.05},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4750.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7538.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7538.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5278.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7538.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7538.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7538.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7538.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7538.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7538.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7538.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6079.32},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5432.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7538.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","code_information":[{"code":"734","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16458.61,"maximum":31191.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31191.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20794.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20794.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21855.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16886.91},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16458.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20794.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20794.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18287.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20794.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20794.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20794.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20794.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20794.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20794.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20794.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21062.75},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18823.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20794.65,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","code_information":[{"code":"735","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9500.86,"maximum":20493.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20493.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13662.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13662.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14358.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9748.1},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9500.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13662.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13662.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10556.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13662.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13662.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13662.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13662.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13662.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13662.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13662.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12158.63},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10865.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13662.14,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","code_information":[{"code":"736","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30818.7,"maximum":50891.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50891.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33927.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33927.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35658.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31620.69},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30818.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33927.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33927.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34243.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33927.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33927.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33927.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33927.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33927.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33927.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33927.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39439.93},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35246.71},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33927.74,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","code_information":[{"code":"737","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15641.43,"maximum":30245.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30245.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20163.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20163.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21192.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16048.47},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15641.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20163.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20163.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17379.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20163.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20163.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20163.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20163.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20163.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20163.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20163.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20016.97},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17888.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20163.68,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"738","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11872.55,"maximum":22170.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22170.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14780.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14780.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15534.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12181.51},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11872.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14780.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14780.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13191.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14780.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14780.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14780.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14780.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14780.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14780.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14780.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15193.79},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13578.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14780.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","code_information":[{"code":"739","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31158.41,"maximum":51004.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51004.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34003.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34003.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35737.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31969.24},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31158.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34003.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34003.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34620.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34003.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34003.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34003.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34003.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34003.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34003.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34003.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39874.67},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35635.23},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34003.2,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","code_information":[{"code":"740","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14231.72,"maximum":26822.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26822.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17881.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17881.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18793.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14602.07},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14231.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17881.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17881.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15813.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17881.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17881.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17881.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17881.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17881.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17881.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17881.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18212.91},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16276.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17881.64,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"741","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10750.89,"maximum":21592.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21592.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14394.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14394.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15129.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11030.66},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10750.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14394.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14394.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11945.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14394.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14394.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14394.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14394.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14394.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14394.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14394.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13758.35},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12295.57},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14394.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14297.47,"maximum":27166.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27166.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18110.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18110.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19034.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14669.53},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14297.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18110.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18110.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15886.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18110.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18110.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18110.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18110.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18110.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18110.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18110.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18297.05},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16351.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18110.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9902.02,"10th_percentile":9902.02,"90th_percentile":9902.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":70938.36,"10th_percentile":70938.36,"90th_percentile":70938.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":96255.16,"10th_percentile":96255.16,"90th_percentile":96255.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7216.55,"10th_percentile":7216.55,"90th_percentile":7216.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":33916.86,"10th_percentile":33916.86,"90th_percentile":33916.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":14940.6,"10th_percentile":14940.6,"90th_percentile":14940.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9381.89,"maximum":19063.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19063.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12709.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12709.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13357.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9626.03},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9381.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12709.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12709.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10424.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12709.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12709.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12709.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12709.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12709.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12709.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12709.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12006.38},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10729.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12709.32,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":60624.1,"10th_percentile":60624.1,"90th_percentile":60624.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7203.67,"10th_percentile":7203.67,"90th_percentile":7789.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8917.56,"10th_percentile":8917.56,"90th_percentile":8917.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15293.9,"maximum":30088.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30088.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20059.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20059.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21082.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15691.89},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15293.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20059.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20059.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16993.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20059.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20059.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20059.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20059.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20059.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20059.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20059.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19572.22},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17491.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20059.12,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6479.31,"10th_percentile":6479.31,"90th_percentile":6479.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15478.02,"10th_percentile":15478.02,"90th_percentile":15478.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","code_information":[{"code":"745","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8021.49,"maximum":17656.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17656.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12371.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8230.23},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8021.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8912.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10265.42},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9174.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.04,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures With Cc/Mcc","code_information":[{"code":"746","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13106.93,"maximum":25833.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25833.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17222.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17222.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18100.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13448.01},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13106.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17222.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17222.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14563.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17222.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17222.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17222.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17222.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17222.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17222.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17222.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16773.47},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14990.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17222.48,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13490.48,"10th_percentile":13490.48,"90th_percentile":13490.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","code_information":[{"code":"747","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7475.92,"maximum":13868.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13868.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9245.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9245.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9716.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7670.47},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7475.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9245.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9245.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8306.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9245.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9245.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9245.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9245.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9245.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9245.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9245.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9567.24},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8550.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9245.34,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Female Reproductive System Reconstructive Procedures","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10662.44,"maximum":21063.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21063.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14042.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14042.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14758.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10939.91},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10662.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14042.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14042.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11847.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14042.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14042.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14042.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14042.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14042.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14042.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14042.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13645.16},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12194.41},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14042.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures With Cc/Mcc","code_information":[{"code":"749","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20260.36,"maximum":37159.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37159.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24773.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24773.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26036.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20787.6},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20260.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24773.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24773.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22511.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24773.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24773.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24773.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24773.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24773.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24773.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24773.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25928.0},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23171.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24773.22,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12583.6,"10th_percentile":12583.6,"90th_percentile":12583.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"750","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10093.39,"maximum":22270.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22270.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14846.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14846.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15603.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10356.05},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10093.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14846.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14846.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11214.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14846.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14846.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14846.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14846.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14846.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14846.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14846.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12916.92},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11543.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14846.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Mcc","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14161.28,"maximum":27260.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27260.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18173.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18173.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19100.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14529.79},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14161.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18173.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18173.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15734.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18173.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18173.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18173.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18173.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18173.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18173.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18173.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18122.76},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16195.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18173.48,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9486.08,"10th_percentile":9486.08,"90th_percentile":9486.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Cc","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8689.16,"maximum":16978.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16978.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11319.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11319.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11896.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8915.28},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8689.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11319.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11319.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9654.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11319.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11319.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11319.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11319.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11319.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11319.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11319.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11119.87},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9937.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11319.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9936.28,"10th_percentile":9936.28,"90th_percentile":9936.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10097.78,"10th_percentile":10097.78,"90th_percentile":10097.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"756","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7474.36,"maximum":15242.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15242.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10161.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10161.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10680.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7668.86},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7474.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10161.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10161.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8304.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10161.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10161.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10161.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10161.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10161.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10161.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10161.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9565.23},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8548.26},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10161.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Mcc","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11077.29,"maximum":21671.50,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21671.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14447.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14447.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15184.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11365.56},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11077.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14447.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14447.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12308.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14447.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14447.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14447.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14447.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14447.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14447.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14447.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14176.06},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12668.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14447.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Cc","code_information":[{"code":"758","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7978.44,"maximum":15495.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15495.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10856.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8186.06},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7978.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8864.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10210.33},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9124.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5008.73,"maximum":11193.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11193.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7462.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7462.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7843.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5139.08},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5008.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7462.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7462.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5565.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7462.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7462.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7462.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7462.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7462.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7462.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7462.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6409.88},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5728.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7462.44,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6034.87,"10th_percentile":6034.87,"90th_percentile":6034.87,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":4697.44,"10th_percentile":4697.44,"90th_percentile":4697.44,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7713.87,"maximum":15883.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15883.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10589.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10589.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11129.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7914.61},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7713.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10589.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10589.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8570.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10589.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10589.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10589.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10589.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10589.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10589.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10589.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9871.75},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8822.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10589.11,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4508.28,"10th_percentile":4508.28,"90th_percentile":4508.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4961.77,"maximum":9924.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9924.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6616.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6616.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6953.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5090.89},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4961.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6616.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6616.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5513.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6616.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6616.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6616.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6616.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6616.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6616.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6616.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6349.78},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5674.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6616.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8581.15,"maximum":16757.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16757.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11171.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11171.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11741.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8804.45},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8581.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11171.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11171.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9534.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11171.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11171.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11171.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11171.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11171.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11171.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11171.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10981.64},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9814.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11171.9,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":14585.03,"10th_percentile":10138.21,"90th_percentile":15138.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6324.74,"10th_percentile":6067.02,"90th_percentile":25862.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14567.0,"10th_percentile":14567.0,"90th_percentile":14567.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":21786.55,"10th_percentile":20359.77,"90th_percentile":29233.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23179.32,"10th_percentile":23179.32,"90th_percentile":29290.08,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"18","median_amount":6163.05,"10th_percentile":4568.23,"90th_percentile":8120.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":13134.97,"10th_percentile":13134.97,"90th_percentile":15797.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"25","median_amount":6427.09,"10th_percentile":4314.2,"90th_percentile":8732.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"12","median_amount":5986.32,"10th_percentile":4798.55,"90th_percentile":7547.74,"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":"1 through 10","median_amount":6278.69,"10th_percentile":6278.69,"90th_percentile":6278.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":4534.0,"10th_percentile":4534.0,"90th_percentile":4534.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10876.13,"maximum":25188.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25188.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16792.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16792.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17648.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11159.16},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10876.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16792.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16792.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12084.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16792.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16792.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16792.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16792.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16792.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16792.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16792.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13918.62},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12438.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16792.44,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15341.35,"10th_percentile":15341.35,"90th_percentile":15341.35,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":878.81,"10th_percentile":878.81,"90th_percentile":878.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3934.7,"10th_percentile":3934.7,"90th_percentile":3934.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8421.47,"maximum":15818.20,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15818.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10545.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10545.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11083.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8640.62},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8421.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10545.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10545.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9357.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10545.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10545.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10545.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10545.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10545.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10545.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10545.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10777.29},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9631.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10545.47,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5584.05,"maximum":11072.30,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11072.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7381.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7381.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7757.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5729.36},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5584.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7381.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7381.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6204.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7381.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7381.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7381.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7381.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7381.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7381.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7381.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7146.13},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6386.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7381.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3370.75,"10th_percentile":3370.75,"90th_percentile":3370.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":6650.09,"10th_percentile":6650.09,"90th_percentile":6650.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5565.62,"10th_percentile":3370.75,"90th_percentile":7017.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":5842.66,"10th_percentile":5090.53,"90th_percentile":32716.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":3082.2,"10th_percentile":3082.2,"90th_percentile":3082.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3165.04,"10th_percentile":2797.76,"90th_percentile":6971.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8652.24,"10th_percentile":8652.24,"90th_percentile":8652.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6816.62,"10th_percentile":6816.62,"90th_percentile":6816.62,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":2369.65,"10th_percentile":2369.65,"90th_percentile":2369.65,"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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion Without D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7316.24,"maximum":13617.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13617.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9078.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9078.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9541.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7506.63},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7316.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9078.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9078.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8129.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9078.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9078.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9078.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9078.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9078.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9078.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9078.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9362.89},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8367.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9078.06,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":21781.95,"10th_percentile":21781.95,"90th_percentile":21781.95,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14418.02,"maximum":35625.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35625.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23750.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23750.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24961.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14793.21},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14418.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23750.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23750.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16020.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23750.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23750.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23750.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23750.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23750.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23750.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23750.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18451.31},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16489.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23750.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7214.11,"10th_percentile":7214.11,"90th_percentile":7214.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9014.64,"10th_percentile":9014.64,"90th_percentile":9014.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8711.16,"10th_percentile":8711.16,"90th_percentile":8711.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8477.04,"maximum":16601.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16601.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11067.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11067.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11631.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8697.64},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8477.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11067.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11067.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9418.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11067.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11067.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11067.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11067.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11067.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11067.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11067.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10848.41},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9695.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11067.34,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":40832.5,"10th_percentile":40832.5,"90th_percentile":40832.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31387.05,"10th_percentile":31387.05,"90th_percentile":31387.05,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":51416.26,"10th_percentile":51416.26,"90th_percentile":51416.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9249.07,"10th_percentile":7832.35,"90th_percentile":11609.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":8521.55,"10th_percentile":7989.0,"90th_percentile":11541.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6848.17,"maximum":15205.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15205.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10137.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10137.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10654.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7026.37},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6848.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10137.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10137.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7609.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10137.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10137.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10137.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10137.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10137.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10137.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10137.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8763.87},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7832.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10137.25,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":10888.33,"10th_percentile":10888.33,"90th_percentile":10888.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7248.53,"10th_percentile":7248.53,"90th_percentile":7834.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":32286.11,"10th_percentile":32286.11,"90th_percentile":32286.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"14","median_amount":7183.8,"10th_percentile":6105.52,"90th_percentile":7795.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7946.93,"10th_percentile":7946.93,"90th_percentile":7946.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":6874.0,"10th_percentile":6874.0,"90th_percentile":6874.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12647.46,"maximum":24639.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24639.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16426.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16426.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17263.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12976.59},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12647.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16426.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16426.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14052.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16426.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16426.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16426.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16426.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16426.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16426.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16426.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16185.47},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14464.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16426.04,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":12958.19,"10th_percentile":12958.19,"90th_percentile":12958.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11337.47,"10th_percentile":9882.77,"90th_percentile":17663.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":44778.27,"10th_percentile":44778.27,"90th_percentile":47013.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44716.15,"10th_percentile":44716.15,"90th_percentile":44716.15,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":47958.93,"10th_percentile":46357.66,"90th_percentile":50955.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":6874.0,"10th_percentile":6668.45,"90th_percentile":7694.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, 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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":9769.38,"10th_percentile":9769.38,"90th_percentile":9769.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8311.1,"maximum":17374.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17374.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11582.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11582.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12173.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8527.38},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8311.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11582.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11582.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9234.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11582.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11582.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11582.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11582.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11582.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11582.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11582.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10636.05},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9505.23},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11582.84,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":12173.49,"10th_percentile":10504.36,"90th_percentile":12852.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9195.92,"10th_percentile":8064.78,"90th_percentile":11251.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":40108.24,"10th_percentile":36487.97,"90th_percentile":49662.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37918.97,"10th_percentile":37918.97,"90th_percentile":46020.3,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"12","median_amount":43817.88,"10th_percentile":29120.11,"90th_percentile":54271.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":17150.99,"10th_percentile":17150.99,"90th_percentile":17406.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":8064.81,"10th_percentile":6508.1,"90th_percentile":10342.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9245.09,"10th_percentile":9055.19,"90th_percentile":12118.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10014.45,"10th_percentile":7253.56,"90th_percentile":12302.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":5829.0,"10th_percentile":5829.0,"90th_percentile":6155.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":6610.72,"10th_percentile":6610.72,"90th_percentile":6610.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7083.77,"maximum":15219.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15219.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10146.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10146.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10663.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7268.11},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7083.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10146.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10146.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7870.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10146.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10146.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10146.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10146.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10146.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10146.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10146.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9065.39},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8101.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10146.34,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":11705.48,"10th_percentile":11705.48,"90th_percentile":11705.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"14","median_amount":6974.21,"10th_percentile":6055.45,"90th_percentile":7695.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":42552.69,"10th_percentile":27612.89,"90th_percentile":45107.57,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34553.92,"10th_percentile":32364.37,"90th_percentile":48047.87,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"46","median_amount":7426.65,"10th_percentile":6379.65,"90th_percentile":9704.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"24","median_amount":40170.19,"10th_percentile":29862.75,"90th_percentile":45846.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":14657.86,"10th_percentile":13877.67,"90th_percentile":14795.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"56","median_amount":7429.03,"10th_percentile":6012.31,"90th_percentile":9623.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6787.87,"10th_percentile":6508.1,"90th_percentile":8284.1,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7880.17,"10th_percentile":7703.26,"90th_percentile":8399.71,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":7538.6,"10th_percentile":6261.2,"90th_percentile":7564.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":35609.5,"10th_percentile":35609.5,"90th_percentile":35609.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7688.39,"10th_percentile":7688.39,"90th_percentile":7688.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14110.4,"maximum":26721.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26721.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17814.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17814.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18722.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14477.59},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14110.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17814.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17814.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15678.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17814.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17814.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17814.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17814.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17814.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17814.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17814.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18057.65},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16137.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17814.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":4778.7,"10th_percentile":4778.7,"90th_percentile":4778.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4545.85,"10th_percentile":4545.85,"90th_percentile":4545.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":8995.92,"10th_percentile":8995.92,"90th_percentile":8995.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1512.51,"10th_percentile":1425.64,"90th_percentile":4665.25,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":8830.78,"10th_percentile":8830.78,"90th_percentile":8830.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":19952.03,"10th_percentile":3209.99,"90th_percentile":23604.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4692.25,"10th_percentile":4692.25,"90th_percentile":4692.25,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1542.76,"10th_percentile":1542.76,"90th_percentile":1542.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":1626.14,"10th_percentile":1626.14,"90th_percentile":1626.14,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46533.71,"maximum":83199.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83199.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55466.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55466.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58294.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":47744.65},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46533.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55466.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55466.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51704.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55466.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55466.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55466.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55466.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55466.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55466.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55466.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59551.07},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53219.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55466.2,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":7833.03,"10th_percentile":7833.03,"90th_percentile":7833.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10092.8,"10th_percentile":10092.8,"90th_percentile":10092.8,"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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":148313.58,"10th_percentile":148313.58,"90th_percentile":148313.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":21506.33,"10th_percentile":6233.84,"90th_percentile":46466.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":14246.59,"10th_percentile":14246.59,"90th_percentile":14246.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4406.38,"10th_percentile":4406.38,"90th_percentile":4406.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31779.9,"maximum":57499.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57499.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38332.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38332.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40287.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":32606.91},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31779.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38332.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38332.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35311.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38332.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38332.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38332.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38332.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38332.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38332.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38332.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40670.02},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36346.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38332.72,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":6209.84,"10th_percentile":6209.84,"90th_percentile":6209.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2445.79,"10th_percentile":2445.79,"90th_percentile":2445.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":50787.93,"10th_percentile":50787.93,"90th_percentile":50787.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43127.96,"10th_percentile":43127.96,"90th_percentile":43127.96,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":24322.48,"10th_percentile":14743.32,"90th_percentile":36104.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":7943.39,"10th_percentile":7943.39,"90th_percentile":7943.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":17111.55,"10th_percentile":12029.98,"90th_percentile":33239.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":18337.32,"10th_percentile":18337.32,"90th_percentile":18337.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19175.49,"maximum":35545.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35545.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23696.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23696.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24905.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19674.49},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19175.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23696.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23696.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21306.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23696.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23696.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23696.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23696.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23696.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23696.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23696.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24539.65},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21930.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23696.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":1707.6,"10th_percentile":1512.51,"90th_percentile":21176.65,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":6834.9,"10th_percentile":4480.22,"90th_percentile":131576.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":888.81,"10th_percentile":888.81,"90th_percentile":888.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"20","median_amount":2307.6,"10th_percentile":1548.02,"90th_percentile":19883.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2339.51,"10th_percentile":1579.37,"90th_percentile":25428.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1610.96,"10th_percentile":1610.96,"90th_percentile":5083.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":5043.92,"10th_percentile":5043.92,"90th_percentile":5043.92,"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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32644.83,"maximum":59007.40,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59007.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39338.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39338.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41344.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":33494.34},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32644.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39338.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39338.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36272.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39338.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39338.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39338.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39338.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39338.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39338.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39338.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41776.9},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37335.21},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39338.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3672.74,"10th_percentile":1972.72,"90th_percentile":4810.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":4388.22,"10th_percentile":2819.98,"90th_percentile":12186.72,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":6409.3,"10th_percentile":3976.62,"90th_percentile":7367.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":11699.29,"10th_percentile":11699.29,"90th_percentile":11699.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"27","median_amount":3394.28,"10th_percentile":2228.78,"90th_percentile":12554.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6209.84,"10th_percentile":5824.72,"90th_percentile":11279.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2367.88,"10th_percentile":2367.88,"90th_percentile":2367.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":26570.71,"10th_percentile":26570.71,"90th_percentile":26570.71,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11554.76,"maximum":22271.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22271.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14847.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14847.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15604.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11855.45},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11554.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14847.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14847.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12838.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14847.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14847.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14847.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14847.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14847.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14847.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14847.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14787.1},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13214.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14847.71,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"13","median_amount":2872.39,"10th_percentile":1001.11,"90th_percentile":4127.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"42","median_amount":1848.05,"10th_percentile":1279.39,"90th_percentile":3346.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":4709.5,"10th_percentile":3042.22,"90th_percentile":22283.01,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4235.22,"10th_percentile":3346.17,"90th_percentile":19197.1,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":1928.78,"10th_percentile":1279.37,"90th_percentile":4813.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"41","median_amount":4188.22,"10th_percentile":2906.69,"90th_percentile":7546.22,"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":2635.25,"10th_percentile":2635.25,"90th_percentile":2635.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"155","median_amount":1845.79,"10th_percentile":1488.81,"90th_percentile":3119.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":1879.37,"10th_percentile":1488.82,"90th_percentile":3046.16,"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":"26","median_amount":1518.6,"10th_percentile":1245.79,"90th_percentile":2012.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"12","median_amount":2528.0,"10th_percentile":1283.0,"90th_percentile":5323.12,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":3579.9,"10th_percentile":2040.0,"90th_percentile":19243.75,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages 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":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."}]}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1563.91,"maximum":4868.50,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4868.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":3411.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":1604.61},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":1563.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":1737.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2001.4},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":1788.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"22","median_amount":3089.52,"10th_percentile":888.81,"90th_percentile":3926.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"80","median_amount":1548.05,"10th_percentile":1188.83,"90th_percentile":1879.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":979.37,"10th_percentile":979.37,"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":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"27","median_amount":2967.43,"10th_percentile":2133.63,"90th_percentile":5221.22,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"30","median_amount":4106.22,"10th_percentile":2488.5,"90th_percentile":5548.81,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"193","median_amount":1488.82,"10th_percentile":1188.82,"90th_percentile":1877.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"97","median_amount":3915.22,"10th_percentile":2414.22,"90th_percentile":5601.65,"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":"11","median_amount":1071.78,"10th_percentile":666.2,"90th_percentile":1779.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"327","median_amount":1488.81,"10th_percentile":1188.81,"90th_percentile":1879.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"92","median_amount":1548.03,"10th_percentile":1188.82,"90th_percentile":1848.03,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"41","median_amount":1610.96,"10th_percentile":1212.6,"90th_percentile":1824.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"24","median_amount":1900.01,"10th_percentile":1064.0,"90th_percentile":2528.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, 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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":2260.0,"10th_percentile":1648.0,"90th_percentile":3390.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1579.37,"10th_percentile":1579.37,"90th_percentile":1579.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"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":9992.42,"maximum":18058.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18058.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12039.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12039.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12653.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10252.45},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9992.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12039.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12039.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11102.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12039.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12039.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12039.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12039.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12039.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12039.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12039.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12787.7},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11428.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12039.25,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":43427.47,"10th_percentile":43427.47,"90th_percentile":43427.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Cc","code_information":[{"code":"797","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7578.46,"maximum":15786.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15786.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10524.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10524.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11061.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7775.67},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7578.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10524.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10524.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8420.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10524.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10524.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10524.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10524.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10524.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10524.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10524.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9698.46},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8667.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10524.56,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1187.77,"10th_percentile":1187.77,"90th_percentile":1187.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7898.65,"10th_percentile":7898.65,"90th_percentile":7898.65,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8170.16,"10th_percentile":7837.61,"90th_percentile":9048.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7856.31,"10th_percentile":7856.31,"90th_percentile":7856.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7732.39,"10th_percentile":7732.39,"90th_percentile":7732.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24892.6,"maximum":46067.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46067.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30711.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30711.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32278.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25540.38},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24892.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30711.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30711.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27658.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30711.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30711.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30711.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30711.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30711.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30711.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30711.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31856.06},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28469.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30711.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","code_information":[{"code":"933","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33866.68,"maximum":55251.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55251.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36834.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36834.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38712.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":34747.99},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33866.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36834.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36834.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37629.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36834.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36834.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36834.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36834.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36834.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36834.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36834.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43340.55},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38732.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36834.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn Without Skin Graft Or Inhalation Injury","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16795.19,"maximum":32291.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32291.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21527.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21527.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22625.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17232.25},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16795.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21527.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21527.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18661.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21527.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21527.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21527.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21527.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21527.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21527.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21527.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21493.48},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19208.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21527.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive Burns","code_information":[{"code":"935","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17191.25,"maximum":30237.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30237.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20158.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20158.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21186.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17638.62},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17191.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20158.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20158.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19101.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20158.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20158.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20158.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20158.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20158.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20158.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20158.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22000.34},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19661.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20158.22,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","code_information":[{"code":"939","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24842.51,"maximum":51628.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51628.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34418.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34418.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36174.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25488.98},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24842.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34418.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34418.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27602.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34418.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34418.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34418.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34418.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34418.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34418.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34418.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31791.95},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28411.86},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34418.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16525.93,"maximum":34013.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34013.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22675.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22675.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23832.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16955.98},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16525.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22675.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22675.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18362.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22675.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22675.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22675.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22675.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22675.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22675.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22675.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21148.89},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18900.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22675.74,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":58011.85,"10th_percentile":58011.85,"90th_percentile":58011.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15296.25,"maximum":29796.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29796.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19864.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19864.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20877.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15694.3},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15296.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19864.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19864.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16995.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19864.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19864.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19864.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19864.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19864.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19864.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19864.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19575.22},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17494.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19864.56,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":17286.78,"10th_percentile":17286.78,"90th_percentile":17286.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation With Cc/Mcc","code_information":[{"code":"945","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11947.7,"maximum":23263.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23263.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15508.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15508.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16299.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12258.61},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11947.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15508.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15508.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13275.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15508.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15508.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15508.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15508.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15508.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15508.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15508.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15289.95},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13664.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15508.68,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation Without Cc/Mcc","code_information":[{"code":"946","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8738.48,"maximum":17783.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17783.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11855.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11855.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12460.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8965.88},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8738.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11855.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11855.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9709.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11855.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11855.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11855.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11855.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11855.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11855.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11855.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11182.98},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9994.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11855.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10066.78,"maximum":19455.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19455.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13631.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":10328.75},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10066.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":11185.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12882.86},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11513.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.25,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10836.71,"10th_percentile":7820.77,"90th_percentile":13365.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47014.0,"10th_percentile":47014.0,"90th_percentile":47014.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":62658.34,"10th_percentile":62658.34,"90th_percentile":62658.34,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":61760.82,"10th_percentile":61760.82,"90th_percentile":66463.43,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5856.13,"10th_percentile":5856.13,"90th_percentile":5856.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":14256.48,"10th_percentile":14256.48,"90th_percentile":14256.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35824.43,"10th_percentile":35824.43,"90th_percentile":35824.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":17339.4,"10th_percentile":17339.4,"90th_percentile":17339.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":16431.73,"10th_percentile":16431.73,"90th_percentile":16431.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19945.14,"10th_percentile":15027.44,"90th_percentile":37802.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6218.85,"maximum":13060.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13060.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8707.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8707.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9151.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":6380.68},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6218.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8707.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8707.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":6909.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8707.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8707.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8707.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8707.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8707.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8707.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8707.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7958.51},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7112.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8707.11,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12293.09,"10th_percentile":12293.09,"90th_percentile":12293.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22281.65,"10th_percentile":22281.65,"90th_percentile":22281.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":27675.17,"10th_percentile":27675.17,"90th_percentile":27675.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11863.8,"10th_percentile":11583.39,"90th_percentile":14256.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":28558.41,"10th_percentile":28558.41,"90th_percentile":57633.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5904.37,"10th_percentile":4455.15,"90th_percentile":9801.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6923.32,"10th_percentile":6923.32,"90th_percentile":6923.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"1 through 10","median_amount":15395.54,"10th_percentile":15395.54,"90th_percentile":15395.54,"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: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33440.03,"10th_percentile":33440.03,"90th_percentile":33440.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8444.95,"maximum":18368.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18368.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12245.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12245.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12870.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8664.71},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8444.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12245.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12245.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":9383.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12245.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12245.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12245.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12245.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12245.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12245.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12245.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10807.34},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9658.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12245.64,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":14379.36,"10th_percentile":14379.36,"90th_percentile":14379.36,"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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":66760.06,"10th_percentile":66760.06,"90th_percentile":145453.03,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":123520.44,"10th_percentile":123520.44,"90th_percentile":123520.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25446.92,"10th_percentile":25446.92,"90th_percentile":25446.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32762.31,"10th_percentile":32762.31,"90th_percentile":32762.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21053.34,"10th_percentile":21053.34,"90th_percentile":21053.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4587.62,"maximum":10704.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10704.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7136.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7136.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7499.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":4707.0},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4587.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7136.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7136.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5097.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7136.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7136.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7136.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7136.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7136.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7136.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7136.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5870.96},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5246.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7136.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Factors Influencing Health Status","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4437.34,"maximum":9726.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9726.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6484.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6484.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6814.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":4552.81},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":4437.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6484.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6484.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":4930.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6484.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6484.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6484.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6484.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6484.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6484.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6484.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5678.64},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5074.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6484.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":4302.35,"10th_percentile":4302.35,"90th_percentile":4302.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":58944.7,"10th_percentile":58944.7,"90th_percentile":58944.7,"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 * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5409.57,"10th_percentile":5409.57,"90th_percentile":5409.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5182.39,"10th_percentile":5182.39,"90th_percentile":5182.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":53444.5,"maximum":93940.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93940.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62626.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62626.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65820.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":54835.27},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53444.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62626.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62626.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":59382.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62626.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62626.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62626.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62626.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62626.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62626.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62626.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68395.07},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":61123.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62626.9,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29917.77,"maximum":53462.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53462.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35641.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35641.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37459.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30696.32},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29917.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35641.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35641.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33241.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35641.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35641.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35641.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35641.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35641.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35641.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35641.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38286.98},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34216.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35641.55,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Mcc","code_information":[{"code":"957","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":58421.14,"maximum":106061.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106061.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70707.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70707.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74313.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":59941.42},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58421.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70707.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70707.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":64912.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70707.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70707.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70707.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70707.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70707.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70707.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70707.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74763.88},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66815.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70707.68,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Cc","code_information":[{"code":"958","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32166.58,"maximum":59611.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59611.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39741.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39741.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41767.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":33003.64},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32166.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39741.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39741.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35740.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39741.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39741.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39741.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39741.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39741.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39741.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39741.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41164.86},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36788.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39741.04,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":13596.61,"10th_percentile":13596.61,"90th_percentile":13596.61,"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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20693.22,"maximum":42294.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42294.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28196.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28196.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29634.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21231.71},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20693.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28196.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28196.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22992.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28196.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28196.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28196.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28196.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28196.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28196.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28196.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26481.94},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23666.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28196.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21263.83,"maximum":39426.40,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39426.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26284.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26284.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27624.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21817.18},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21263.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26284.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26284.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23626.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26284.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26284.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26284.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26284.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26284.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26284.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26284.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27212.18},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24319.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26284.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21886.42,"10th_percentile":21886.42,"90th_percentile":21886.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Cc","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11742.62,"maximum":23044.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23044.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15363.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15363.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16146.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":12048.2},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11742.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15363.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15363.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":13047.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15363.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15363.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15363.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15363.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15363.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15363.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15363.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15027.5},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13429.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15363.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10826.47,"10th_percentile":10826.47,"90th_percentile":10826.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7142.48,"maximum":14969.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14969.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9979.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9979.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10488.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":7328.34},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7142.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9979.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9979.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":7936.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9979.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9979.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9979.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9979.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9979.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9979.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9979.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9140.51},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8168.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9979.96,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures With Mcc","code_information":[{"code":"969","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49499.51,"maximum":85624.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85624.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57082.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57082.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59993.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":50787.62},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49499.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57082.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57082.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54999.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57082.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57082.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57082.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57082.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57082.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57082.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57082.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63346.51},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56611.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57082.72,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":54520.02,"10th_percentile":54520.02,"90th_percentile":54520.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":99647.99,"10th_percentile":99647.99,"90th_percentile":99647.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures Without Mcc","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20767.58,"maximum":38111.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38111.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25407.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25407.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26703.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21308.01},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20767.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25407.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25407.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23075.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25407.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25407.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25407.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25407.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25407.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25407.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25407.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26577.1},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23751.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25407.82,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23372.53,"maximum":41502.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41502.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27668.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27668.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29079.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23980.75},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23372.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27668.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27668.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25969.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27668.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27668.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27668.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27668.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27668.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27668.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27668.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29910.76},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26730.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27668.04,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"1 through 10","median_amount":37053.87,"10th_percentile":37053.87,"90th_percentile":37053.87,"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":15137.22,"10th_percentile":15137.22,"90th_percentile":15137.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 18.93]","count":"1 through 10","median_amount":88045.68,"10th_percentile":88045.68,"90th_percentile":88045.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":70459.58,"10th_percentile":70459.58,"90th_percentile":70459.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":88281.21,"10th_percentile":88281.21,"90th_percentile":88281.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":32354.01,"10th_percentile":32354.01,"90th_percentile":32354.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":26191.49,"10th_percentile":26191.49,"90th_percentile":26191.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":744.9,"10th_percentile":744.9,"90th_percentile":744.9,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11125.04,"maximum":19804.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19804.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13203.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13203.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13876.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11414.55},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11125.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13203.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13203.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12361.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13203.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13203.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13203.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13203.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13203.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13203.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13203.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14237.16},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12723.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13203.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11756.15,"10th_percentile":11756.15,"90th_percentile":11756.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6021.3,"10th_percentile":6021.3,"90th_percentile":6021.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition Without Cc/Mcc","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7850.07,"maximum":14454.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14454.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9636.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9636.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10127.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":8054.35},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7850.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9636.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9636.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":8722.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9636.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9636.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9636.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9636.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9636.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9636.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9636.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10046.05},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8977.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9636.29,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Or Without Other Related Condition","code_information":[{"code":"977","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11285.5,"maximum":19841.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19841.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13227.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13227.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13902.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11579.18},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11285.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13227.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13227.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12539.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13227.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13227.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13227.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13227.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13227.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13227.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13227.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14442.51},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12906.99},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13227.55,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37213.67,"maximum":66129.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66129.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44086.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44086.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46334.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":38182.07},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37213.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44086.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44086.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41348.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44086.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44086.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44086.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44086.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44086.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44086.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44086.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47623.82},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42560.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44086.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":20744.21,"10th_percentile":20744.21,"90th_percentile":42689.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38174.56,"10th_percentile":38174.56,"90th_percentile":38174.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"1 through 10","median_amount":299225.91,"10th_percentile":299225.91,"90th_percentile":299225.91,"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":"1 through 10","median_amount":36366.33,"10th_percentile":36366.33,"90th_percentile":36366.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19165.32,"maximum":35671.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35671.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23781.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23781.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24994.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19664.05},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19165.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23781.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23781.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21294.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23781.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23781.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23781.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23781.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23781.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23781.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23781.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24526.62},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21918.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23781.3,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1048.93,"10th_percentile":1048.93,"90th_percentile":1048.93,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20004.15,"10th_percentile":20004.15,"90th_percentile":20004.15,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13056.84,"maximum":25518.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25518.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17012.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17012.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17880.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13396.61},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13056.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17012.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17012.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14507.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17012.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17012.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17012.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17012.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17012.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17012.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17012.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16709.36},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14932.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17012.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27419.28,"maximum":48899.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48899.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32599.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32599.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34262.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28132.8},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27419.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32599.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32599.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30465.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32599.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32599.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32599.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32599.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32599.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32599.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32599.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35089.55},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31358.86},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32599.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":27944.13,"10th_percentile":27944.13,"90th_percentile":27944.13,"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":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"988","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13431.77,"maximum":24558.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24558.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16372.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16372.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17207.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":13781.3},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13431.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16372.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16372.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":14924.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16372.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16372.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16372.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16372.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16372.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16372.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16372.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17189.17},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15361.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16372.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":13892.57,"10th_percentile":13892.57,"90th_percentile":13892.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9414.63,"10th_percentile":9414.63,"90th_percentile":11637.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":66400.38,"10th_percentile":66400.38,"90th_percentile":66400.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14421.97,"10th_percentile":14421.97,"90th_percentile":14421.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"989","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9043.74,"maximum":18498.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18498.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12332.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12332.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12960.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":9279.09},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9043.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12332.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12332.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":10048.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12332.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12332.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12332.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12332.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12332.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12332.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12332.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11573.64},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10343.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12332.01,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6303.07,"10th_percentile":6303.07,"90th_percentile":6303.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":51305.09,"10th_percentile":51305.09,"90th_percentile":51305.09,"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":9996.72,"10th_percentile":9996.72,"90th_percentile":9996.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pmkr, dual, leadless","code_information":[{"code":"2046","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19983.56,"10th_percentile":19983.56,"90th_percentile":19983.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"97","median_amount":73.33,"10th_percentile":6.44,"90th_percentile":220.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"73","median_amount":206.93,"10th_percentile":135.09,"90th_percentile":270.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"396","median_amount":131.65,"10th_percentile":92.45,"90th_percentile":132.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":132.19,"10th_percentile":125.5,"90th_percentile":264.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"212","median_amount":283.0,"10th_percentile":154.59,"90th_percentile":961.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"166","median_amount":20.0,"10th_percentile":8.83,"90th_percentile":50.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"298","median_amount":193.0,"10th_percentile":140.0,"90th_percentile":238.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"114","median_amount":134.34,"10th_percentile":53.74,"90th_percentile":134.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"148","median_amount":124.94,"10th_percentile":118.61,"90th_percentile":132.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"789","median_amount":259.0,"10th_percentile":140.0,"90th_percentile":745.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"89","median_amount":67.99,"10th_percentile":44.1,"90th_percentile":206.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":440.22,"10th_percentile":251.5,"90th_percentile":748.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"301","median_amount":193.0,"10th_percentile":170.53,"90th_percentile":293.48,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"556","median_amount":131.65,"10th_percentile":124.99,"90th_percentile":131.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":131.65,"10th_percentile":124.99,"90th_percentile":658.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"134","median_amount":193.0,"10th_percentile":140.0,"90th_percentile":302.1,"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 ($): FEE SCHEDULE]","count":"27","median_amount":132.19,"10th_percentile":125.5,"90th_percentile":134.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"33","median_amount":193.0,"10th_percentile":173.76,"90th_percentile":307.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"134","median_amount":158.25,"10th_percentile":34.81,"90th_percentile":252.95,"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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"38","median_amount":27.84,"10th_percentile":4.83,"90th_percentile":188.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"321","median_amount":131.66,"10th_percentile":84.26,"90th_percentile":134.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":215.53,"10th_percentile":215.53,"90th_percentile":215.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"12","median_amount":137.69,"10th_percentile":113.95,"90th_percentile":182.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"72","median_amount":243.76,"10th_percentile":215.53,"90th_percentile":314.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":90.66,"10th_percentile":90.66,"90th_percentile":91.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":90.32,"10th_percentile":90.32,"90th_percentile":90.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"40","median_amount":809.0,"10th_percentile":294.24,"90th_percentile":1141.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"32","median_amount":862.0,"10th_percentile":440.0,"90th_percentile":1804.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"191","median_amount":218.6,"10th_percentile":214.36,"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":"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":85.36,"10th_percentile":64.0,"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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"132","median_amount":902.21,"10th_percentile":440.0,"90th_percentile":1547.79,"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":"13","median_amount":277.48,"10th_percentile":175.19,"90th_percentile":381.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"236","median_amount":259.14,"10th_percentile":206.93,"90th_percentile":314.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":91.79,"10th_percentile":89.95,"90th_percentile":91.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"83","median_amount":215.53,"10th_percentile":214.36,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":90.32,"10th_percentile":71.96,"90th_percentile":90.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"16","median_amount":295.23,"10th_percentile":164.74,"90th_percentile":321.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"27","median_amount":785.7,"10th_percentile":171.0,"90th_percentile":1123.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":568.64,"10th_percentile":373.78,"90th_percentile":761.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":2.11,"10th_percentile":1.76,"90th_percentile":91.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":259.14,"10th_percentile":215.53,"90th_percentile":324.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"39","median_amount":308.25,"10th_percentile":185.72,"90th_percentile":638.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"110","median_amount":228.88,"10th_percentile":153.31,"90th_percentile":353.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":164.77,"10th_percentile":162.88,"90th_percentile":393.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":271.52,"10th_percentile":162.44,"90th_percentile":361.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"60","median_amount":1531.0,"10th_percentile":719.0,"90th_percentile":3054.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"62","median_amount":1407.0,"10th_percentile":728.0,"90th_percentile":2807.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"294","median_amount":252.96,"10th_percentile":161.51,"90th_percentile":380.29,"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 ($): FEE SCHEDULE]","count":"11","median_amount":165.08,"10th_percentile":165.08,"90th_percentile":275.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":153.52,"10th_percentile":146.75,"90th_percentile":263.69,"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":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"202","median_amount":1414.0,"10th_percentile":799.16,"90th_percentile":2982.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"34","median_amount":480.2,"10th_percentile":284.56,"90th_percentile":1008.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":164.58,"10th_percentile":147.91,"90th_percentile":313.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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":"429","median_amount":259.14,"10th_percentile":153.31,"90th_percentile":353.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":57.4,"10th_percentile":57.4,"90th_percentile":57.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"54","median_amount":133.21,"10th_percentile":24.58,"90th_percentile":261.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":129.42,"10th_percentile":129.42,"90th_percentile":162.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":55.08,"10th_percentile":55.08,"90th_percentile":55.08,"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":"179","median_amount":245.56,"10th_percentile":157.82,"90th_percentile":380.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":162.44,"10th_percentile":162.44,"90th_percentile":162.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"78","median_amount":267.44,"10th_percentile":164.74,"90th_percentile":414.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"44","median_amount":919.0,"10th_percentile":388.24,"90th_percentile":1123.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"11","median_amount":960.0,"10th_percentile":689.25,"90th_percentile":1003.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"40","median_amount":164.28,"10th_percentile":73.58,"90th_percentile":393.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":220.49,"10th_percentile":187.79,"90th_percentile":337.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"187","median_amount":432.96,"10th_percentile":198.02,"90th_percentile":1066.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"354","median_amount":270.27,"10th_percentile":157.82,"90th_percentile":596.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"108","median_amount":285.37,"10th_percentile":160.37,"90th_percentile":590.46,"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 ($): FEE SCHEDULE]","count":"23","median_amount":284.02,"10th_percentile":270.89,"90th_percentile":495.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"275","median_amount":2332.41,"10th_percentile":1485.84,"90th_percentile":4602.72,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"234","median_amount":2478.81,"10th_percentile":1573.82,"90th_percentile":5250.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"1062","median_amount":256.56,"10th_percentile":161.51,"90th_percentile":568.5,"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 ($): FEE SCHEDULE]","count":"39","median_amount":399.49,"10th_percentile":163.64,"90th_percentile":648.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"51","median_amount":268.44,"10th_percentile":268.44,"90th_percentile":486.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"880","median_amount":2527.83,"10th_percentile":1568.51,"90th_percentile":5104.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"144","median_amount":819.51,"10th_percentile":324.8,"90th_percentile":1824.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":262.79,"10th_percentile":223.41,"90th_percentile":294.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":390.26,"10th_percentile":390.26,"90th_percentile":390.26,"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":"1260","median_amount":259.14,"10th_percentile":161.51,"90th_percentile":572.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":463.84,"10th_percentile":166.38,"90th_percentile":675.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"195","median_amount":271.67,"10th_percentile":89.95,"90th_percentile":581.81,"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 ($): FEE SCHEDULE]","count":"28","median_amount":393.1,"10th_percentile":226.29,"90th_percentile":746.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"661","median_amount":270.27,"10th_percentile":161.51,"90th_percentile":577.34,"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 ($): FEE SCHEDULE]","count":"21","median_amount":284.02,"10th_percentile":226.29,"90th_percentile":513.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"274","median_amount":243.76,"10th_percentile":160.98,"90th_percentile":486.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"212","median_amount":1053.54,"10th_percentile":415.14,"90th_percentile":1123.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"27","median_amount":1003.0,"10th_percentile":597.1,"90th_percentile":1003.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"154","median_amount":285.37,"10th_percentile":194.67,"90th_percentile":529.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"55","median_amount":242.86,"10th_percentile":189.49,"90th_percentile":591.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"360","median_amount":850.74,"10th_percentile":391.01,"90th_percentile":1747.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"580","median_amount":346.93,"10th_percentile":190.65,"90th_percentile":960.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"224","median_amount":622.31,"10th_percentile":282.87,"90th_percentile":1065.01,"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 ($): FEE SCHEDULE]","count":"32","median_amount":595.6,"10th_percentile":348.0,"90th_percentile":964.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"456","median_amount":4696.88,"10th_percentile":2722.53,"90th_percentile":9484.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"363","median_amount":4970.28,"10th_percentile":2932.81,"90th_percentile":9528.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"1775","median_amount":348.39,"10th_percentile":190.65,"90th_percentile":964.84,"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 ($): FEE SCHEDULE]","count":"82","median_amount":663.51,"10th_percentile":361.37,"90th_percentile":1011.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"117","median_amount":601.26,"10th_percentile":412.81,"90th_percentile":982.19,"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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1524","median_amount":4593.53,"10th_percentile":2792.0,"90th_percentile":9450.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"194","median_amount":1286.14,"10th_percentile":478.48,"90th_percentile":2911.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"41","median_amount":644.5,"10th_percentile":312.5,"90th_percentile":899.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":435.0,"10th_percentile":347.15,"90th_percentile":1021.04,"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":"2123","median_amount":349.36,"10th_percentile":190.65,"90th_percentile":999.7,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":694.69,"10th_percentile":694.69,"90th_percentile":694.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"490","median_amount":543.63,"10th_percentile":164.58,"90th_percentile":1032.45,"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 ($): FEE SCHEDULE]","count":"45","median_amount":593.15,"10th_percentile":226.29,"90th_percentile":884.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":595.94,"10th_percentile":595.94,"90th_percentile":595.94,"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":"1057","median_amount":342.6,"10th_percentile":190.65,"90th_percentile":1126.77,"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 ($): FEE SCHEDULE]","count":"65","median_amount":571.84,"10th_percentile":348.0,"90th_percentile":1080.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"451","median_amount":339.74,"10th_percentile":194.46,"90th_percentile":921.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"372","median_amount":1072.0,"10th_percentile":423.0,"90th_percentile":1123.27,"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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"45","median_amount":1003.0,"10th_percentile":562.4,"90th_percentile":1072.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"341","median_amount":636.11,"10th_percentile":285.67,"90th_percentile":1064.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"70","median_amount":301.48,"10th_percentile":190.82,"90th_percentile":778.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"134","median_amount":1526.55,"10th_percentile":758.99,"90th_percentile":4141.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"305","median_amount":845.81,"10th_percentile":275.95,"90th_percentile":1915.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"210","median_amount":2337.35,"10th_percentile":547.14,"90th_percentile":2711.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"35","median_amount":931.51,"10th_percentile":501.06,"90th_percentile":2715.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"138","median_amount":10174.16,"10th_percentile":4906.74,"90th_percentile":20412.05,"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":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"140","median_amount":10367.77,"10th_percentile":4933.0,"90th_percentile":21496.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"698","median_amount":788.01,"10th_percentile":262.56,"90th_percentile":1864.34,"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 ($): FEE SCHEDULE]","count":"84","median_amount":2760.05,"10th_percentile":858.74,"90th_percentile":2940.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"93","median_amount":2456.14,"10th_percentile":727.02,"90th_percentile":2579.3,"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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"503","median_amount":10215.32,"10th_percentile":4464.0,"90th_percentile":20009.53,"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":"72","median_amount":2985.85,"10th_percentile":919.12,"90th_percentile":6320.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"53","median_amount":2567.65,"10th_percentile":670.99,"90th_percentile":2744.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1070.97,"10th_percentile":626.33,"90th_percentile":2704.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"794","median_amount":792.92,"10th_percentile":254.22,"90th_percentile":2104.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":391.5,"10th_percentile":391.5,"90th_percentile":391.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"394","median_amount":2317.75,"10th_percentile":496.38,"90th_percentile":2807.48,"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 ($): FEE SCHEDULE]","count":"49","median_amount":1270.29,"10th_percentile":545.86,"90th_percentile":2177.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":815.66,"10th_percentile":763.19,"90th_percentile":1211.79,"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":"487","median_amount":790.4,"10th_percentile":273.88,"90th_percentile":2052.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"70","median_amount":2070.55,"10th_percentile":640.84,"90th_percentile":2177.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"197","median_amount":720.7,"10th_percentile":248.64,"90th_percentile":1683.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"163","median_amount":1123.0,"10th_percentile":657.6,"90th_percentile":2394.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"21","median_amount":802.4,"10th_percentile":562.4,"90th_percentile":2139.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"293","median_amount":2490.19,"10th_percentile":628.09,"90th_percentile":2707.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"81","median_amount":344.04,"10th_percentile":269.82,"90th_percentile":877.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":2167.56,"10th_percentile":2167.56,"90th_percentile":2167.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1664.79,"10th_percentile":489.55,"90th_percentile":3809.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1967.56,"10th_percentile":1815.6,"90th_percentile":2722.97,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":11820.74,"10th_percentile":6495.25,"90th_percentile":24512.29,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"18","median_amount":1020.48,"10th_percentile":561.56,"90th_percentile":1924.01,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2764.43,"10th_percentile":2764.43,"90th_percentile":2815.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1254.31,"10th_percentile":1254.31,"90th_percentile":9702.37,"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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":23697.81,"10th_percentile":6948.03,"90th_percentile":34489.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2758.91,"10th_percentile":2758.91,"90th_percentile":2758.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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":1357.31,"10th_percentile":369.92,"90th_percentile":2556.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2528.45,"10th_percentile":773.09,"90th_percentile":2704.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1044.33,"10th_percentile":1044.33,"90th_percentile":1044.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":830.14,"10th_percentile":721.66,"90th_percentile":2425.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1828.32,"10th_percentile":390.84,"90th_percentile":3500.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":1675.42,"10th_percentile":1057.68,"90th_percentile":3109.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1916.98,"10th_percentile":1092.59,"90th_percentile":2580.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":637.67,"10th_percentile":637.67,"90th_percentile":637.67,"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."}]}]},{"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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"11","median_amount":362.94,"10th_percentile":247.62,"90th_percentile":513.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":469.3,"10th_percentile":207.33,"90th_percentile":607.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":249.98,"10th_percentile":92.45,"90th_percentile":394.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"14","median_amount":1267.02,"10th_percentile":236.0,"90th_percentile":3181.57,"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":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":3174.67,"10th_percentile":2833.38,"90th_percentile":13997.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":450.57,"10th_percentile":207.33,"90th_percentile":539.82,"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":"1 through 10","median_amount":192.63,"10th_percentile":192.63,"90th_percentile":192.63,"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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"43","median_amount":2759.05,"10th_percentile":757.02,"90th_percentile":4039.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":976.08,"10th_percentile":328.3,"90th_percentile":1017.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"28","median_amount":469.3,"10th_percentile":228.88,"90th_percentile":680.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":239.63,"10th_percentile":131.65,"90th_percentile":282.87,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":529.11,"10th_percentile":529.11,"90th_percentile":529.11,"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":469.3,"10th_percentile":240.42,"90th_percentile":469.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":348.0,"10th_percentile":348.0,"90th_percentile":348.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":478.68,"10th_percentile":478.68,"90th_percentile":478.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"12","median_amount":898.4,"10th_percentile":250.0,"90th_percentile":1123.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":270.79,"10th_percentile":162.78,"90th_percentile":421.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"23","median_amount":717.51,"10th_percentile":326.52,"90th_percentile":1249.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"27","median_amount":528.01,"10th_percentile":460.26,"90th_percentile":1639.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"65","median_amount":806.3,"10th_percentile":408.75,"90th_percentile":1282.75,"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 ($): FEE SCHEDULE]","count":"15","median_amount":542.01,"10th_percentile":326.52,"90th_percentile":1493.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"54","median_amount":2142.0,"10th_percentile":1314.0,"90th_percentile":3244.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"15","median_amount":2402.87,"10th_percentile":60.0,"90th_percentile":16377.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":1006.85,"10th_percentile":460.26,"90th_percentile":2477.84,"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 ($): FEE SCHEDULE]","count":"17","median_amount":797.54,"10th_percentile":550.82,"90th_percentile":1383.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":774.66,"10th_percentile":512.27,"90th_percentile":1431.2,"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":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"100","median_amount":2189.0,"10th_percentile":1314.0,"90th_percentile":7281.46,"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":"11","median_amount":771.99,"10th_percentile":567.7,"90th_percentile":2156.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":190.12,"10th_percentile":178.76,"90th_percentile":951.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"101","median_amount":619.4,"10th_percentile":460.26,"90th_percentile":1718.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"100","median_amount":674.2,"10th_percentile":408.15,"90th_percentile":1508.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":614.72,"10th_percentile":489.78,"90th_percentile":1356.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"57","median_amount":692.68,"10th_percentile":460.26,"90th_percentile":1397.13,"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 ($): FEE SCHEDULE]","count":"14","median_amount":951.83,"10th_percentile":542.01,"90th_percentile":1523.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"19","median_amount":488.99,"10th_percentile":488.99,"90th_percentile":2820.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"14","median_amount":729.0,"10th_percentile":413.1,"90th_percentile":2809.38,"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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":464.0,"10th_percentile":464.0,"90th_percentile":464.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"71","median_amount":671.48,"10th_percentile":409.82,"90th_percentile":979.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2701.73,"10th_percentile":479.4,"90th_percentile":3030.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1264.73,"10th_percentile":678.59,"90th_percentile":2375.44,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2412.43,"10th_percentile":2200.7,"90th_percentile":2775.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":4846.0,"10th_percentile":3652.0,"90th_percentile":5574.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":2291.63,"10th_percentile":132.57,"90th_percentile":2492.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":1275.34,"10th_percentile":920.52,"90th_percentile":3239.02,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":772.44,"10th_percentile":772.44,"90th_percentile":1596.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1024.46,"10th_percentile":1024.46,"90th_percentile":2373.72,"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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":2741.07,"10th_percentile":2476.7,"90th_percentile":11124.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":770.7,"10th_percentile":770.7,"90th_percentile":770.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"31","median_amount":1224.43,"10th_percentile":460.26,"90th_percentile":3673.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1273.32,"10th_percentile":771.01,"90th_percentile":2007.67,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1165.14,"10th_percentile":1033.49,"90th_percentile":1165.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":1224.43,"10th_percentile":692.68,"90th_percentile":2550.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2045.53,"10th_percentile":2045.53,"90th_percentile":2045.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":154.07,"10th_percentile":154.07,"90th_percentile":1300.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":486.0,"10th_percentile":486.0,"90th_percentile":1320.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1020.32,"10th_percentile":843.85,"90th_percentile":1338.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":2495.64,"10th_percentile":2495.64,"90th_percentile":2860.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3146.59,"10th_percentile":2438.31,"90th_percentile":7772.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"13","median_amount":3574.98,"10th_percentile":1895.69,"90th_percentile":6348.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":4569.52,"10th_percentile":2537.05,"90th_percentile":23324.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":11458.3,"10th_percentile":160.0,"90th_percentile":15457.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"28","median_amount":3499.81,"10th_percentile":1718.2,"90th_percentile":10220.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[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":4321.35,"10th_percentile":4252.63,"90th_percentile":5096.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"25","median_amount":11268.0,"10th_percentile":2953.0,"90th_percentile":17526.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5192.52,"10th_percentile":5192.52,"90th_percentile":5192.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"81","median_amount":4946.19,"10th_percentile":2176.43,"90th_percentile":9363.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":803.1,"10th_percentile":394.95,"90th_percentile":4145.54,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1148.45,"10th_percentile":1148.45,"90th_percentile":3876.51,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":2319.0,"10th_percentile":2319.0,"90th_percentile":2319.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":3224.84,"10th_percentile":2286.15,"90th_percentile":4811.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":7221.99,"10th_percentile":2438.31,"90th_percentile":8247.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4876.62,"10th_percentile":4876.62,"90th_percentile":4876.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":5272.0,"10th_percentile":5272.0,"90th_percentile":5272.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6784.62,"10th_percentile":3739.95,"90th_percentile":7609.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyperbaric Oxygen","code_information":[{"code":"5061","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"114","median_amount":862.5,"10th_percentile":803.28,"90th_percentile":862.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":575.0,"10th_percentile":134.34,"90th_percentile":575.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":534.75,"10th_percentile":534.75,"90th_percentile":534.75,"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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"64","median_amount":3212.0,"10th_percentile":3212.0,"90th_percentile":3212.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"83","median_amount":460.26,"10th_percentile":460.26,"90th_percentile":479.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"86","median_amount":563.9,"10th_percentile":524.81,"90th_percentile":563.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"44","median_amount":479.4,"10th_percentile":479.4,"90th_percentile":479.4,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":488.99,"10th_percentile":488.99,"90th_percentile":488.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"17","median_amount":1762.0,"10th_percentile":1542.51,"90th_percentile":1762.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"89","median_amount":563.5,"10th_percentile":280.28,"90th_percentile":568.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"18","median_amount":1097.43,"10th_percentile":862.17,"90th_percentile":1100.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"12","median_amount":823.3,"10th_percentile":740.97,"90th_percentile":1730.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":725.77,"10th_percentile":375.77,"90th_percentile":804.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"19","median_amount":5234.86,"10th_percentile":3551.58,"90th_percentile":10442.67,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"22","median_amount":5244.73,"10th_percentile":3418.0,"90th_percentile":10323.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"26","median_amount":857.53,"10th_percentile":512.93,"90th_percentile":1026.33,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":821.11,"10th_percentile":821.11,"90th_percentile":821.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":682.1,"10th_percentile":682.1,"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":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"52","median_amount":3927.64,"10th_percentile":2047.0,"90th_percentile":7144.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":1196.3,"10th_percentile":464.98,"90th_percentile":2217.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":808.19,"10th_percentile":547.27,"90th_percentile":831.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"30","median_amount":857.53,"10th_percentile":823.3,"90th_percentile":1286.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":721.77,"10th_percentile":657.69,"90th_percentile":812.69,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":738.27,"10th_percentile":738.27,"90th_percentile":738.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"17","median_amount":823.3,"10th_percentile":506.93,"90th_percentile":1308.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":723.61,"10th_percentile":723.61,"90th_percentile":807.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1714.79,"10th_percentile":1714.79,"90th_percentile":1714.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":1220.0,"10th_percentile":1220.0,"90th_percentile":1220.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":1091.0,"10th_percentile":1091.0,"90th_percentile":1091.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":721.71,"10th_percentile":670.28,"90th_percentile":1086.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"35","median_amount":2292.69,"10th_percentile":1533.46,"90th_percentile":2664.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"14","median_amount":1838.7,"10th_percentile":1458.11,"90th_percentile":2750.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"29","median_amount":1660.26,"10th_percentile":1412.2,"90th_percentile":1748.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2906.29,"10th_percentile":2906.29,"90th_percentile":2906.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"33","median_amount":8401.9,"10th_percentile":5826.97,"90th_percentile":18027.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"58","median_amount":9197.03,"10th_percentile":5716.32,"90th_percentile":19299.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"43","median_amount":1638.32,"10th_percentile":115.89,"90th_percentile":1730.57,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1688.97,"10th_percentile":1688.97,"90th_percentile":1776.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1730.57,"10th_percentile":1570.74,"90th_percentile":2774.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"106","median_amount":7542.81,"10th_percentile":5223.77,"90th_percentile":17108.31,"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":"13","median_amount":4529.98,"10th_percentile":1849.89,"90th_percentile":6992.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"65","median_amount":1661.49,"10th_percentile":1224.43,"90th_percentile":2550.68,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1171.17,"10th_percentile":1171.17,"90th_percentile":1171.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"32","median_amount":1569.68,"10th_percentile":1324.16,"90th_percentile":1741.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1392.9,"10th_percentile":1324.16,"90th_percentile":1751.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1518.74,"10th_percentile":1518.74,"90th_percentile":1518.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[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":1730.57,"10th_percentile":1603.91,"90th_percentile":2234.14,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1664.24,"10th_percentile":1661.95,"90th_percentile":1730.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1744.5,"10th_percentile":924.17,"90th_percentile":5678.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"19","median_amount":1729.0,"10th_percentile":1729.0,"90th_percentile":2233.5,"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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":1546.0,"10th_percentile":1546.0,"90th_percentile":1546.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":1661.95,"10th_percentile":1410.08,"90th_percentile":1769.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":4430.42,"10th_percentile":2339.34,"90th_percentile":5070.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2247.22,"10th_percentile":2247.22,"90th_percentile":2729.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2923.79,"10th_percentile":2580.79,"90th_percentile":2930.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":14133.41,"10th_percentile":10827.68,"90th_percentile":21330.68,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":15640.01,"10th_percentile":11990.0,"90th_percentile":34695.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":2155.26,"90th_percentile":4236.89,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"34","median_amount":14066.81,"10th_percentile":8879.61,"90th_percentile":24150.72,"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":3830.35,"10th_percentile":3821.9,"90th_percentile":5035.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2824.07,"10th_percentile":2157.51,"90th_percentile":3036.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2465.79,"10th_percentile":935.61,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2935.72,"10th_percentile":2935.72,"90th_percentile":2935.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2247.22,"10th_percentile":2247.22,"90th_percentile":2907.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2416.06,"10th_percentile":2416.06,"90th_percentile":2416.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":3261.6,"10th_percentile":2943.79,"90th_percentile":3673.34,"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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2928.8,"10th_percentile":2928.8,"90th_percentile":2928.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":5887.58,"10th_percentile":4699.57,"90th_percentile":9437.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1670.6,"10th_percentile":1670.6,"90th_percentile":1670.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3911.89,"10th_percentile":3911.89,"90th_percentile":6667.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":14806.44,"10th_percentile":11380.15,"90th_percentile":43388.19,"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":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":16060.6,"10th_percentile":13104.4,"90th_percentile":46427.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":1670.6,"10th_percentile":1670.6,"90th_percentile":6898.9,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3991.72,"10th_percentile":3991.72,"90th_percentile":6798.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"20","median_amount":17805.25,"10th_percentile":13772.34,"90th_percentile":41910.98,"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":14311.6,"10th_percentile":14311.6,"90th_percentile":14311.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3916.87,"10th_percentile":3916.87,"90th_percentile":3916.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6898.91,"10th_percentile":2505.9,"90th_percentile":7700.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3914.89,"10th_percentile":3764.89,"90th_percentile":6670.14,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6689.33,"10th_percentile":6689.33,"90th_percentile":6689.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1670.6,"10th_percentile":1622.9,"90th_percentile":2505.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3927.85,"10th_percentile":3927.85,"90th_percentile":3927.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6059.85,"10th_percentile":6059.85,"90th_percentile":6059.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":3490.19,"10th_percentile":2899.2,"90th_percentile":3624.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":5176.66,"10th_percentile":5176.66,"90th_percentile":5176.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6662.14,"10th_percentile":3912.39,"90th_percentile":6689.34,"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."}]}]},{"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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":15458.17,"10th_percentile":15458.17,"90th_percentile":20394.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7048.34,"10th_percentile":6666.52,"90th_percentile":15238.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":63767.93,"10th_percentile":63767.93,"90th_percentile":63767.93,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":86229.41,"10th_percentile":86229.41,"90th_percentile":108873.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7176.59,"10th_percentile":7176.59,"90th_percentile":7176.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":60713.59,"10th_percentile":44991.84,"90th_percentile":61214.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9849.73,"10th_percentile":9604.03,"90th_percentile":10260.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10534.44,"10th_percentile":10534.44,"90th_percentile":10534.44,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11196.98,"10th_percentile":11196.98,"90th_percentile":11196.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":9459.22,"10th_percentile":9459.22,"90th_percentile":9459.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5636.78,"10th_percentile":5636.78,"90th_percentile":5636.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":24807.34,"10th_percentile":24807.34,"90th_percentile":24807.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":106011.41,"10th_percentile":106011.41,"90th_percentile":106011.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 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":25575.87,"10th_percentile":25575.87,"90th_percentile":25575.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":16594.23,"10th_percentile":16594.23,"90th_percentile":16594.23,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":146.72,"10th_percentile":146.72,"90th_percentile":3715.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1130.76,"10th_percentile":1130.76,"90th_percentile":1130.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":881.22,"10th_percentile":881.22,"90th_percentile":881.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"21","median_amount":1590.43,"10th_percentile":308.0,"90th_percentile":4949.08,"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":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":3265.25,"10th_percentile":3265.25,"90th_percentile":3265.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":1149.37,"10th_percentile":629.77,"90th_percentile":2092.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":956.74,"10th_percentile":926.6,"90th_percentile":1023.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":708.79,"10th_percentile":249.88,"90th_percentile":736.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":4003.53,"10th_percentile":1550.0,"90th_percentile":15165.8,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"16","median_amount":381.1,"10th_percentile":145.02,"90th_percentile":521.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1196.91,"10th_percentile":848.98,"90th_percentile":1493.74,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1069.25,"10th_percentile":1069.25,"90th_percentile":1069.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":351.53,"10th_percentile":351.53,"90th_percentile":351.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":1458.0,"10th_percentile":1458.0,"90th_percentile":2588.55,"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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":292.86,"10th_percentile":292.86,"90th_percentile":292.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Strapping and Cast Application","code_information":[{"code":"5102","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":406.97,"10th_percentile":406.97,"90th_percentile":830.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":225.81,"10th_percentile":225.81,"90th_percentile":225.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":272.14,"10th_percentile":271.81,"90th_percentile":272.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":831.0,"10th_percentile":780.64,"90th_percentile":1662.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":30.0,"10th_percentile":30.0,"90th_percentile":40.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":497.72,"10th_percentile":497.72,"90th_percentile":1090.72,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":259.12,"10th_percentile":259.12,"90th_percentile":259.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":257.47,"10th_percentile":257.47,"90th_percentile":257.47,"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":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"21","median_amount":831.0,"10th_percentile":775.33,"90th_percentile":831.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":290.85,"10th_percentile":290.85,"90th_percentile":290.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":219.37,"10th_percentile":219.37,"90th_percentile":451.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":271.81,"10th_percentile":271.81,"90th_percentile":271.81,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":217.05,"10th_percentile":217.05,"90th_percentile":217.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":225.81,"10th_percentile":225.81,"90th_percentile":451.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":272.42,"10th_percentile":272.42,"90th_percentile":272.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":178.0,"10th_percentile":178.0,"90th_percentile":178.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":271.32,"10th_percentile":217.06,"90th_percentile":434.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":2679.03,"10th_percentile":2679.03,"90th_percentile":2679.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":892.04,"10th_percentile":892.04,"90th_percentile":1058.55,"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":"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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":3926.47,"10th_percentile":2156.88,"90th_percentile":71350.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":1713.25,"10th_percentile":1713.25,"90th_percentile":1713.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":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":"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":390.73,"10th_percentile":390.73,"90th_percentile":390.73,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":895.25,"10th_percentile":895.25,"90th_percentile":895.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":547.4,"10th_percentile":547.4,"90th_percentile":547.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":1123.0,"10th_percentile":1123.0,"90th_percentile":1123.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"17","median_amount":2502.45,"10th_percentile":2262.45,"90th_percentile":2502.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":1638.32,"10th_percentile":999.66,"90th_percentile":2578.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1639.93,"10th_percentile":1634.93,"90th_percentile":2326.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"19","median_amount":11357.89,"10th_percentile":6290.27,"90th_percentile":16599.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":9217.82,"10th_percentile":8012.33,"90th_percentile":13612.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":1638.32,"10th_percentile":577.61,"90th_percentile":2701.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1668.3,"10th_percentile":1668.3,"90th_percentile":1668.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1551.52,"10th_percentile":1551.52,"90th_percentile":1551.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"46","median_amount":9866.43,"10th_percentile":6952.91,"90th_percentile":13650.02,"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":3046.19,"10th_percentile":1825.25,"90th_percentile":4878.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"23","median_amount":1572.92,"10th_percentile":577.61,"90th_percentile":2578.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"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":1637.93,"10th_percentile":1487.93,"90th_percentile":1639.93,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1572.92,"10th_percentile":1058.55,"90th_percentile":2624.59,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":589.16,"10th_percentile":589.16,"90th_percentile":1671.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":1729.0,"10th_percentile":1000.0,"90th_percentile":4339.34,"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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":1003.0,"10th_percentile":1003.0,"90th_percentile":1003.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1635.94,"10th_percentile":1546.74,"90th_percentile":1637.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"11","median_amount":5073.38,"10th_percentile":2505.28,"90th_percentile":5534.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2686.13,"10th_percentile":2578.9,"90th_percentile":8499.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2947.59,"10th_percentile":2947.1,"90th_percentile":3321.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"16","median_amount":27279.55,"10th_percentile":21209.08,"90th_percentile":34882.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"23","median_amount":25969.45,"10th_percentile":17458.77,"90th_percentile":35864.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"18","median_amount":6025.11,"10th_percentile":2683.79,"90th_percentile":7134.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"62","median_amount":23764.54,"10th_percentile":14983.02,"90th_percentile":41230.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":7791.98,"10th_percentile":4265.87,"90th_percentile":12952.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"18","median_amount":2686.13,"10th_percentile":2578.9,"90th_percentile":7688.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3317.6,"10th_percentile":3063.61,"90th_percentile":3317.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2686.13,"10th_percentile":2683.79,"90th_percentile":7164.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2737.47,"10th_percentile":2737.47,"90th_percentile":2737.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"13","median_amount":4904.26,"10th_percentile":3332.44,"90th_percentile":5436.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":8102.17,"10th_percentile":4711.0,"90th_percentile":11050.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2683.79,"10th_percentile":2651.69,"90th_percentile":6381.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"32","median_amount":11032.47,"10th_percentile":9057.03,"90th_percentile":11592.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":8142.01,"10th_percentile":6435.27,"90th_percentile":8538.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":7281.83,"10th_percentile":6954.83,"90th_percentile":7304.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"29","median_amount":31861.42,"10th_percentile":23502.98,"90th_percentile":50959.67,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"24","median_amount":43194.5,"10th_percentile":29603.11,"90th_percentile":64198.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":8046.75,"10th_percentile":528.01,"90th_percentile":8723.88,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7446.77,"10th_percentile":7405.66,"90th_percentile":7626.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6925.5,"10th_percentile":6925.5,"90th_percentile":6925.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"95","median_amount":39565.97,"10th_percentile":25747.76,"90th_percentile":58445.23,"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":"15","median_amount":10874.46,"10th_percentile":6047.06,"90th_percentile":19028.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6910.73,"10th_percentile":6910.73,"90th_percentile":6910.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"32","median_amount":6624.43,"10th_percentile":5949.41,"90th_percentile":8817.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":7297.83,"10th_percentile":6905.83,"90th_percentile":7480.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"23","median_amount":7125.39,"10th_percentile":6196.79,"90th_percentile":9536.78,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7202.5,"10th_percentile":7202.5,"90th_percentile":7202.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8615.58,"10th_percentile":8452.97,"90th_percentile":8672.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"31","median_amount":7437.52,"10th_percentile":5755.4,"90th_percentile":9860.1,"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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":4983.6,"10th_percentile":3339.72,"90th_percentile":9645.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7298.58,"10th_percentile":6140.76,"90th_percentile":7683.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":20118.95,"10th_percentile":20118.95,"90th_percentile":20118.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":16698.52,"10th_percentile":16698.52,"90th_percentile":18565.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13151.88,"10th_percentile":13151.88,"90th_percentile":13151.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":64470.68,"10th_percentile":64470.68,"90th_percentile":64470.68,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":107646.94,"10th_percentile":73339.28,"90th_percentile":122444.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":9782.24,"10th_percentile":8035.82,"90th_percentile":15143.87,"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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":57687.9,"10th_percentile":52415.11,"90th_percentile":99799.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":38586.98,"10th_percentile":38586.98,"90th_percentile":38586.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11829.94,"10th_percentile":11829.94,"90th_percentile":11829.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13173.93,"10th_percentile":13150.38,"90th_percentile":13178.02,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":14429.5,"10th_percentile":13789.32,"90th_percentile":18565.34,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10343.41,"10th_percentile":10343.41,"90th_percentile":10343.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":8885.5,"10th_percentile":8885.5,"90th_percentile":8885.5,"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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10515.5,"10th_percentile":10515.5,"90th_percentile":10515.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Musculoskeletal Procedures","code_information":[{"code":"5116","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":14060.93,"10th_percentile":14060.93,"90th_percentile":14060.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18443.76,"10th_percentile":18443.76,"90th_percentile":18443.76,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":93296.5,"10th_percentile":70292.21,"90th_percentile":105572.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":20902.51,"10th_percentile":20902.51,"90th_percentile":20902.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10326.56,"10th_percentile":10326.56,"90th_percentile":10326.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17828.25,"10th_percentile":17828.25,"90th_percentile":17828.25,"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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":81799.63,"10th_percentile":67681.3,"90th_percentile":121062.3,"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":30017.44,"10th_percentile":30017.44,"90th_percentile":30017.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19133.31,"10th_percentile":19133.31,"90th_percentile":19133.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":20902.51,"10th_percentile":20902.51,"90th_percentile":23384.07,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16913.09,"10th_percentile":16913.09,"90th_percentile":16913.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18789.76,"10th_percentile":18394.76,"90th_percentile":19028.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":21282.21,"10th_percentile":21280.32,"90th_percentile":35756.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":13755.3,"10th_percentile":13755.3,"90th_percentile":13755.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":7856.26,"10th_percentile":7856.26,"90th_percentile":7856.26,"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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18786.76,"10th_percentile":18419.26,"90th_percentile":19177.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Airway Endoscopy","code_information":[{"code":"5151","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"1 through 10","median_amount":188.21,"10th_percentile":188.21,"90th_percentile":188.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1.56,"10th_percentile":1.56,"90th_percentile":1.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":194.83,"10th_percentile":75.23,"90th_percentile":194.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Airway Endoscopy","code_information":[{"code":"5153","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1768.67,"10th_percentile":1768.67,"90th_percentile":1768.67,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":26271.96,"10th_percentile":26271.96,"90th_percentile":26271.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":2250.56,"10th_percentile":2250.56,"90th_percentile":2250.56,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1797.62,"10th_percentile":1797.62,"90th_percentile":1797.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":17615.6,"10th_percentile":16626.62,"90th_percentile":64159.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":4871.36,"10th_percentile":4871.36,"90th_percentile":4871.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1087.76,"10th_percentile":1087.76,"90th_percentile":1087.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[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":1749.67,"10th_percentile":1749.67,"90th_percentile":1763.11,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":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":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":5094.64,"10th_percentile":5094.64,"90th_percentile":10824.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4585.34,"10th_percentile":4585.34,"90th_percentile":4585.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7071.8,"10th_percentile":3766.48,"90th_percentile":7083.56,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5657.43,"10th_percentile":5657.43,"90th_percentile":5657.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":42826.35,"10th_percentile":42826.35,"90th_percentile":42826.35,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":43902.67,"10th_percentile":37494.39,"90th_percentile":57149.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":4585.34,"10th_percentile":4585.34,"90th_percentile":6878.01,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7216.12,"10th_percentile":7216.12,"90th_percentile":7216.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6141.49,"10th_percentile":6141.49,"90th_percentile":6141.49,"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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"14","median_amount":43839.53,"10th_percentile":37341.02,"90th_percentile":56177.43,"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":11980.73,"10th_percentile":11980.73,"90th_percentile":11980.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6753.3,"10th_percentile":6753.3,"90th_percentile":6753.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4585.34,"10th_percentile":4454.41,"90th_percentile":4585.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":6679.8,"10th_percentile":3766.48,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6611.37,"10th_percentile":6611.37,"90th_percentile":11364.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages 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":4402.3,"90th_percentile":6182.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3013.19,"10th_percentile":3013.19,"90th_percentile":3013.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":2593.5,"10th_percentile":2593.5,"90th_percentile":4412.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":4857.0,"10th_percentile":4857.0,"90th_percentile":4857.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3766.49,"10th_percentile":3295.96,"90th_percentile":7537.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":10205.06,"10th_percentile":8659.34,"90th_percentile":10824.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7071.8,"10th_percentile":7071.8,"90th_percentile":7071.8,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6762.55,"10th_percentile":6762.55,"90th_percentile":6762.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":44236.9,"10th_percentile":44236.9,"90th_percentile":44236.9,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":44850.18,"10th_percentile":32743.35,"90th_percentile":47690.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":6515.57,"10th_percentile":6515.57,"90th_percentile":6515.57,"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":"Medicare Managed Care Plan","methodology":"other","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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":35355.95,"10th_percentile":28430.35,"90th_percentile":48097.25,"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":13376.49,"10th_percentile":13376.49,"90th_percentile":14472.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7225.94,"10th_percentile":7225.94,"90th_percentile":10225.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7079.8,"10th_percentile":7079.8,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":7909.35,"10th_percentile":7909.35,"90th_percentile":7909.35,"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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6841.5,"10th_percentile":6841.5,"90th_percentile":6841.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1265.53,"10th_percentile":1265.53,"90th_percentile":1265.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":237.23,"10th_percentile":237.23,"90th_percentile":237.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 ENT Procedures","code_information":[{"code":"5162","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":651.0,"10th_percentile":651.0,"90th_percentile":651.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 ENT Procedures","code_information":[{"code":"5164","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":5070.96,"10th_percentile":4470.96,"90th_percentile":11894.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4924.69,"10th_percentile":4924.69,"90th_percentile":4924.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":43937.69,"10th_percentile":43937.69,"90th_percentile":43937.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":23009.62,"10th_percentile":18303.82,"90th_percentile":26461.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":5999.1,"10th_percentile":5999.1,"90th_percentile":5999.1,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"28","median_amount":24917.18,"10th_percentile":10572.58,"90th_percentile":47821.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":10552.03,"10th_percentile":10552.03,"90th_percentile":10552.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5569.16,"10th_percentile":5569.16,"90th_percentile":5569.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3313.03,"10th_percentile":3313.03,"90th_percentile":3313.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5023.18,"10th_percentile":5023.18,"90th_percentile":5023.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":4148.8,"10th_percentile":4148.8,"90th_percentile":5238.96,"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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":6777.19,"10th_percentile":6777.19,"90th_percentile":6777.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6011.75,"10th_percentile":6011.75,"90th_percentile":6011.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 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":11281.98,"10th_percentile":11281.98,"90th_percentile":11281.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":8171.54,"10th_percentile":8171.54,"90th_percentile":8171.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":1251.08,"10th_percentile":1251.08,"90th_percentile":1251.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":631.6,"10th_percentile":631.6,"90th_percentile":638.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1552.78,"10th_percentile":1552.78,"90th_percentile":1552.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":2938.89,"10th_percentile":2938.89,"90th_percentile":3244.35,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":27007.79,"10th_percentile":27007.79,"90th_percentile":27007.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":925.62,"10th_percentile":888.67,"90th_percentile":3713.59,"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 ($): FEE SCHEDULE]","count":"19","median_amount":736.28,"10th_percentile":644.49,"90th_percentile":1472.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":3244.35,"10th_percentile":3244.35,"90th_percentile":10056.34,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1251.08,"10th_percentile":1251.08,"90th_percentile":1251.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"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":631.6,"10th_percentile":631.6,"90th_percentile":631.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":944.13,"10th_percentile":944.13,"90th_percentile":944.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":1091.0,"10th_percentile":1091.0,"90th_percentile":1091.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":631.61,"10th_percentile":631.61,"90th_percentile":634.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":2429.01,"10th_percentile":2429.01,"90th_percentile":2429.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3134.53,"10th_percentile":3134.53,"90th_percentile":3134.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1593.95,"10th_percentile":1593.95,"90th_percentile":1593.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":5659.09,"10th_percentile":5162.94,"90th_percentile":55808.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":5082.09,"10th_percentile":5062.94,"90th_percentile":6138.94,"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":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":925.62,"10th_percentile":899.19,"90th_percentile":1499.62,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1619.34,"10th_percentile":1619.34,"90th_percentile":1619.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":7077.1,"10th_percentile":5162.94,"90th_percentile":57481.85,"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":1850.25,"10th_percentile":1850.25,"90th_percentile":1850.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":888.67,"10th_percentile":888.67,"90th_percentile":888.67,"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":"1 through 10","median_amount":1439.95,"10th_percentile":998.95,"90th_percentile":1586.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1322.87,"10th_percentile":925.62,"90th_percentile":2396.04,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":944.13,"10th_percentile":944.13,"90th_percentile":944.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":1729.0,"10th_percentile":1729.0,"90th_percentile":2240.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1586.96,"10th_percentile":1351.13,"90th_percentile":3222.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":8571.12,"10th_percentile":4774.53,"90th_percentile":12708.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":2830.69,"10th_percentile":2554.75,"90th_percentile":4583.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3187.4,"10th_percentile":2970.4,"90th_percentile":3373.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3228.52,"10th_percentile":3228.52,"90th_percentile":3228.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"12","median_amount":22312.76,"10th_percentile":12141.18,"90th_percentile":55472.63,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"21","median_amount":15968.27,"10th_percentile":8213.28,"90th_percentile":21264.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":3228.52,"10th_percentile":2554.75,"90th_percentile":4418.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6422.11,"10th_percentile":3281.02,"90th_percentile":11527.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3051.35,"10th_percentile":3051.35,"90th_percentile":3228.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"22","median_amount":18072.03,"10th_percentile":9360.24,"90th_percentile":47972.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":5194.36,"10th_percentile":2956.78,"90th_percentile":7197.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3218.9,"10th_percentile":3218.9,"90th_percentile":3218.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"21","median_amount":3279.26,"10th_percentile":2035.79,"90th_percentile":4242.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"32","median_amount":3215.4,"10th_percentile":2921.4,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3026.25,"10th_percentile":2572.32,"90th_percentile":3228.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3279.26,"10th_percentile":2660.97,"90th_percentile":3415.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3228.52,"10th_percentile":3228.52,"90th_percentile":3228.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2948.75,"10th_percentile":2948.75,"90th_percentile":4378.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":5272.0,"10th_percentile":5033.0,"90th_percentile":5272.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":4330.54,"10th_percentile":4330.54,"90th_percentile":4330.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":3068.64,"10th_percentile":2572.33,"90th_percentile":3228.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Vascular Procedures","code_information":[{"code":"5184","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4417.85,"10th_percentile":4417.85,"90th_percentile":4417.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":27219.24,"10th_percentile":27219.24,"90th_percentile":40566.64,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":31141.25,"10th_percentile":31141.25,"90th_percentile":31141.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":5689.52,"10th_percentile":5689.52,"90th_percentile":6752.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5635.01,"10th_percentile":5635.01,"90th_percentile":5635.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":33119.61,"10th_percentile":33119.61,"90th_percentile":33119.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4575.94,"10th_percentile":4575.94,"90th_percentile":4575.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[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":5522.31,"90th_percentile":5522.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4335.13,"10th_percentile":4335.13,"90th_percentile":4335.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4418.51,"10th_percentile":4418.51,"90th_percentile":4418.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":7512.27,"10th_percentile":7512.27,"90th_percentile":7512.27,"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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":4850.5,"10th_percentile":4716.06,"90th_percentile":5029.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3608.95,"10th_percentile":3029.45,"90th_percentile":6042.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3293.29,"10th_percentile":3285.79,"90th_percentile":3306.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"15","median_amount":26490.92,"10th_percentile":23203.12,"90th_percentile":42939.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":26736.35,"10th_percentile":24216.34,"90th_percentile":46525.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"44","median_amount":3029.45,"10th_percentile":2908.52,"90th_percentile":5078.19,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3352.85,"10th_percentile":3118.15,"90th_percentile":3366.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3118.15,"10th_percentile":3118.15,"90th_percentile":3130.6,"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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"35","median_amount":28330.66,"10th_percentile":23443.39,"90th_percentile":45500.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":13382.17,"10th_percentile":8606.51,"90th_percentile":27122.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2967.29,"10th_percentile":2620.28,"90th_percentile":3289.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"22","median_amount":3029.45,"10th_percentile":2908.52,"90th_percentile":5976.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[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":"46","median_amount":3285.79,"10th_percentile":3004.91,"90th_percentile":3301.91,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3312.32,"10th_percentile":3312.32,"90th_percentile":3312.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3242.85,"10th_percentile":3242.85,"90th_percentile":3242.85,"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":"17","median_amount":3029.45,"10th_percentile":2908.52,"90th_percentile":4385.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3029.45,"10th_percentile":2957.46,"90th_percentile":3312.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5283.31,"10th_percentile":3090.04,"90th_percentile":6525.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":6071.0,"10th_percentile":5087.22,"90th_percentile":6359.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":5684.0,"10th_percentile":5684.0,"90th_percentile":5684.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":3029.45,"10th_percentile":2628.64,"90th_percentile":3298.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Endovascular Procedures","code_information":[{"code":"5192","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10321.71,"10th_percentile":10321.71,"90th_percentile":10321.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7350.5,"10th_percentile":7350.5,"90th_percentile":7350.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":40900.19,"10th_percentile":40900.19,"90th_percentile":40900.19,"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":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":17112.36,"10th_percentile":17112.36,"90th_percentile":17112.36,"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":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":4626.65,"10th_percentile":4626.65,"90th_percentile":4626.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"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":5527.34,"10th_percentile":5527.34,"90th_percentile":5527.34,"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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":55230.64,"10th_percentile":24791.12,"90th_percentile":86268.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5824.51,"10th_percentile":5824.51,"90th_percentile":7803.82,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8121.3,"10th_percentile":7117.31,"90th_percentile":13351.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":7855.0,"10th_percentile":7855.0,"90th_percentile":7855.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5832.42,"10th_percentile":5832.02,"90th_percentile":5837.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"12","median_amount":17723.58,"10th_percentile":15603.83,"90th_percentile":17752.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":13327.4,"10th_percentile":13327.4,"90th_percentile":15265.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":11572.33,"10th_percentile":11242.21,"90th_percentile":11598.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":86629.9,"10th_percentile":50421.56,"90th_percentile":124916.87,"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":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"11","median_amount":68830.39,"10th_percentile":34354.64,"90th_percentile":94309.88,"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":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"28","median_amount":13327.4,"10th_percentile":10348.0,"90th_percentile":15867.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11835.03,"10th_percentile":11835.03,"90th_percentile":11835.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10994.13,"10th_percentile":10994.13,"90th_percentile":10994.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"26","median_amount":72284.46,"10th_percentile":57375.8,"90th_percentile":90374.96,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11601.83,"10th_percentile":11601.83,"90th_percentile":11601.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"13","median_amount":12812.01,"10th_percentile":11384.32,"90th_percentile":14412.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10181.69,"10th_percentile":10181.69,"90th_percentile":10181.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"31","median_amount":11451.33,"10th_percentile":11193.21,"90th_percentile":11601.33,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11632.49,"10th_percentile":11632.49,"90th_percentile":11632.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3107.18,"10th_percentile":3044.69,"90th_percentile":15246.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11645.61,"10th_percentile":11645.61,"90th_percentile":11645.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":15448.74,"10th_percentile":15448.74,"90th_percentile":22702.5,"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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":19279.0,"10th_percentile":19279.0,"90th_percentile":19279.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":11632.5,"10th_percentile":11354.91,"90th_percentile":18357.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":13342.64,"10th_percentile":13342.64,"90th_percentile":13342.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":70267.15,"10th_percentile":70267.15,"90th_percentile":70267.15,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":34878.03,"10th_percentile":34878.03,"90th_percentile":34878.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":22926.68,"10th_percentile":22926.68,"90th_percentile":22926.68,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18731.83,"10th_percentile":18731.83,"90th_percentile":18731.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":102770.33,"10th_percentile":69560.46,"90th_percentile":264961.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18324.87,"10th_percentile":18324.87,"90th_percentile":18324.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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":18344.07,"10th_percentile":18344.07,"90th_percentile":18360.19,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":13230.99,"10th_percentile":13230.99,"90th_percentile":13230.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":14675.25,"10th_percentile":14675.25,"90th_percentile":14675.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18418.95,"10th_percentile":18418.95,"90th_percentile":18418.95,"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":"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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":53003.24,"10th_percentile":53003.24,"90th_percentile":53003.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"1 through 10","median_amount":7356.29,"10th_percentile":7356.29,"90th_percentile":7356.29,"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":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":59896.74,"10th_percentile":59896.74,"90th_percentile":59896.74,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"17","median_amount":38359.44,"10th_percentile":33038.79,"90th_percentile":38359.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":21947.71,"10th_percentile":21071.56,"90th_percentile":21947.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"29","median_amount":25062.43,"10th_percentile":24694.0,"90th_percentile":25070.47,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"12","median_amount":129449.61,"10th_percentile":119616.8,"90th_percentile":167930.76,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"18","median_amount":168922.7,"10th_percentile":89906.36,"90th_percentile":199886.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"19","median_amount":21947.71,"10th_percentile":21071.56,"90th_percentile":32921.57,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":25522.96,"10th_percentile":25522.96,"90th_percentile":25572.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":23782.85,"10th_percentile":23782.85,"90th_percentile":23782.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"29","median_amount":123810.2,"10th_percentile":86361.66,"90th_percentile":202950.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":28416.69,"10th_percentile":25156.02,"90th_percentile":43541.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":24890.0,"10th_percentile":24890.0,"90th_percentile":24890.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":21071.56,"10th_percentile":21071.56,"90th_percentile":22146.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":22560.35,"10th_percentile":22560.35,"90th_percentile":22560.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"44","median_amount":25061.5,"10th_percentile":24669.5,"90th_percentile":25069.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":21947.71,"10th_percentile":21097.01,"90th_percentile":32921.57,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21947.71,"10th_percentile":21947.71,"90th_percentile":21947.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":22386.66,"10th_percentile":22386.66,"90th_percentile":22386.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"17","median_amount":8504.86,"10th_percentile":6515.32,"90th_percentile":35802.14,"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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":25061.51,"10th_percentile":20413.76,"90th_percentile":25066.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":12940.58,"10th_percentile":12940.58,"90th_percentile":12940.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8424.51,"10th_percentile":8424.51,"90th_percentile":8424.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":12144.79,"10th_percentile":12144.79,"90th_percentile":12144.79,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8627.05,"10th_percentile":8627.05,"90th_percentile":8627.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":35955.47,"10th_percentile":35955.47,"90th_percentile":50104.85,"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":11403.79,"10th_percentile":11403.79,"90th_percentile":11403.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":15956.5,"10th_percentile":15956.5,"90th_percentile":15956.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8464.38,"10th_percentile":8464.38,"90th_percentile":8464.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12144.79,"10th_percentile":12144.79,"90th_percentile":12144.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":10880.0,"10th_percentile":10880.0,"90th_percentile":10880.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":6981.66,"10th_percentile":6981.66,"90th_percentile":6981.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pacemaker and Similar Procedures","code_information":[{"code":"5223","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11345.68,"10th_percentile":11345.68,"90th_percentile":11345.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19139.56,"10th_percentile":19139.56,"90th_percentile":19497.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":51293.53,"10th_percentile":51293.53,"90th_percentile":51293.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":13491.05,"10th_percentile":13491.05,"90th_percentile":13491.05,"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":"1 through 10","median_amount":10145.62,"10th_percentile":10145.62,"90th_percentile":10145.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":41784.21,"10th_percentile":41784.21,"90th_percentile":41784.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11204.16,"10th_percentile":11204.16,"90th_percentile":11204.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10544.08,"10th_percentile":10102.9,"90th_percentile":10696.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10734.72,"10th_percentile":10734.72,"90th_percentile":10734.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11204.16,"10th_percentile":11204.16,"90th_percentile":11204.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10303.99,"10th_percentile":8552.88,"90th_percentile":10698.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Pacemaker and Similar Procedures","code_information":[{"code":"5224","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":29820.24,"10th_percentile":29820.24,"90th_percentile":29820.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19124.86,"10th_percentile":19124.86,"90th_percentile":19124.86,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":15632.59,"10th_percentile":15632.59,"90th_percentile":15632.59,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19880.16,"10th_percentile":19880.16,"90th_percentile":19880.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19311.06,"10th_percentile":19311.06,"90th_percentile":19311.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":17369.55,"10th_percentile":17369.55,"90th_percentile":17369.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19490.56,"10th_percentile":19490.56,"90th_percentile":19490.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":18000.81,"10th_percentile":18000.81,"90th_percentile":18000.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18000.81,"10th_percentile":18000.81,"90th_percentile":18000.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":22938.39,"10th_percentile":22938.39,"90th_percentile":22938.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 ICD and Similar Procedures","code_information":[{"code":"5232","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":50132.45,"10th_percentile":50132.45,"90th_percentile":50132.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":29442.17,"10th_percentile":29442.17,"90th_percentile":29442.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":257492.04,"10th_percentile":257492.04,"90th_percentile":257492.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":29430.6,"10th_percentile":29430.6,"90th_percentile":29430.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":33421.63,"10th_percentile":33421.63,"90th_percentile":33421.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":141589.11,"10th_percentile":131896.9,"90th_percentile":175627.34,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":30941.89,"10th_percentile":30941.89,"90th_percentile":30941.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":29482.88,"10th_percentile":29482.88,"90th_percentile":29482.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":32756.2,"10th_percentile":32753.2,"90th_percentile":32759.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":48626.0,"10th_percentile":48626.0,"90th_percentile":48626.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":535.64,"10th_percentile":535.64,"90th_percentile":535.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":32828.37,"10th_percentile":32828.37,"90th_percentile":32828.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"48","median_amount":1502.6,"10th_percentile":900.08,"90th_percentile":5528.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"17","median_amount":1048.63,"10th_percentile":829.4,"90th_percentile":21001.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"120","median_amount":1285.17,"10th_percentile":429.32,"90th_percentile":5178.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"26","median_amount":7821.4,"10th_percentile":2982.0,"90th_percentile":67146.56,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"21","median_amount":3323.96,"10th_percentile":216.0,"90th_percentile":11844.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":1476.27,"10th_percentile":829.4,"90th_percentile":10511.68,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1029.72,"10th_percentile":901.81,"90th_percentile":8753.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":661.72,"10th_percentile":404.02,"90th_percentile":16038.29,"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":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"141","median_amount":6179.86,"10th_percentile":2347.76,"90th_percentile":61809.13,"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":"20","median_amount":2084.71,"10th_percentile":860.01,"90th_percentile":15566.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":702.99,"10th_percentile":697.3,"90th_percentile":6552.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"26","median_amount":1006.76,"10th_percentile":829.4,"90th_percentile":3077.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"152","median_amount":1055.46,"10th_percentile":605.38,"90th_percentile":12041.66,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":803.34,"10th_percentile":803.34,"90th_percentile":803.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":1165.89,"10th_percentile":796.28,"90th_percentile":12835.35,"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 ($): FEE SCHEDULE]","count":"36","median_amount":1536.18,"10th_percentile":698.32,"90th_percentile":2388.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":223.61,"10th_percentile":223.61,"90th_percentile":223.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"31","median_amount":1415.76,"10th_percentile":318.03,"90th_percentile":13245.9,"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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":1959.19,"10th_percentile":844.81,"90th_percentile":15049.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"70","median_amount":796.83,"10th_percentile":357.01,"90th_percentile":7257.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Blood Product Exchange and Related Services","code_information":[{"code":"5242","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":16698.17,"10th_percentile":16698.17,"90th_percentile":16698.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":35145.31,"10th_percentile":13383.82,"90th_percentile":52394.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12407.2,"10th_percentile":12407.2,"90th_percentile":12407.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":843.64,"10th_percentile":843.64,"90th_percentile":843.64,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"71","median_amount":1466.0,"10th_percentile":1027.27,"90th_percentile":2863.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"30","median_amount":1211.13,"10th_percentile":1162.78,"90th_percentile":1438.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"35","median_amount":965.28,"10th_percentile":614.78,"90th_percentile":1697.97,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1138.77,"10th_percentile":1138.77,"90th_percentile":1138.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"51","median_amount":6381.69,"10th_percentile":3296.17,"90th_percentile":9934.06,"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":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"85","median_amount":7206.35,"10th_percentile":5658.66,"90th_percentile":10222.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"84","median_amount":1211.13,"10th_percentile":906.05,"90th_percentile":1766.2,"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 ($): FEE SCHEDULE]","count":"36","median_amount":977.33,"10th_percentile":727.33,"90th_percentile":977.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":908.92,"10th_percentile":908.92,"90th_percentile":909.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"123","median_amount":7093.39,"10th_percentile":4856.18,"90th_percentile":10621.46,"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":2399.87,"10th_percentile":2136.78,"90th_percentile":13358.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":574.67,"10th_percentile":571.4,"90th_percentile":1188.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1848.24,"10th_percentile":1848.24,"90th_percentile":1848.24,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"122","median_amount":1162.78,"10th_percentile":906.05,"90th_percentile":1237.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":617.01,"10th_percentile":617.01,"90th_percentile":617.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"64","median_amount":960.78,"10th_percentile":810.78,"90th_percentile":1424.36,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":962.49,"10th_percentile":961.69,"90th_percentile":962.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"47","median_amount":1211.13,"10th_percentile":1176.55,"90th_percentile":1813.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":961.69,"10th_percentile":869.88,"90th_percentile":1424.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"20","median_amount":1262.3,"10th_percentile":1186.04,"90th_percentile":2125.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"37","median_amount":1729.0,"10th_percentile":930.25,"90th_percentile":2508.5,"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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":1164.0,"10th_percentile":1046.86,"90th_percentile":1926.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"33","median_amount":962.49,"10th_percentile":766.23,"90th_percentile":1431.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":2966.19,"10th_percentile":2966.19,"90th_percentile":2966.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1176.55,"10th_percentile":1090.02,"90th_percentile":1816.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":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":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":12750.6,"10th_percentile":7234.49,"90th_percentile":22083.53,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":11212.07,"10th_percentile":7574.4,"90th_percentile":22832.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":1211.13,"10th_percentile":1090.02,"90th_percentile":1816.7,"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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":13274.83,"10th_percentile":7454.85,"90th_percentile":13791.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":2683.13,"10th_percentile":2683.13,"90th_percentile":2683.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"14","median_amount":2028.64,"10th_percentile":1211.13,"90th_percentile":3341.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1649.12,"10th_percentile":1649.12,"90th_percentile":1649.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1799.22,"10th_percentile":1790.91,"90th_percentile":1945.91,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2869.28,"10th_percentile":2869.28,"90th_percentile":2869.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1211.13,"10th_percentile":605.57,"90th_percentile":2482.09,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1550.33,"10th_percentile":1550.33,"90th_percentile":1550.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1817.87,"10th_percentile":1817.87,"90th_percentile":1817.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":2319.0,"10th_percentile":1729.0,"90th_percentile":2594.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1937.92,"10th_percentile":1550.34,"90th_percentile":2869.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Upper GI Procedures","code_information":[{"code":"5303","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":61.27,"10th_percentile":61.27,"90th_percentile":61.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":30711.52,"10th_percentile":30711.52,"90th_percentile":30711.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3252.94,"10th_percentile":3252.94,"90th_percentile":3252.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3216.13,"10th_percentile":3216.13,"90th_percentile":3216.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"56","median_amount":1425.57,"10th_percentile":1189.3,"90th_percentile":1425.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"17","median_amount":1237.55,"10th_percentile":1188.15,"90th_percentile":1237.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"51","median_amount":4893.88,"10th_percentile":4282.37,"90th_percentile":5114.79,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"94","median_amount":4942.57,"10th_percentile":4555.19,"90th_percentile":5055.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"44","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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":950.38,"10th_percentile":900.38,"90th_percentile":950.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":883.85,"10th_percentile":883.85,"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":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"177","median_amount":4951.06,"10th_percentile":4571.2,"90th_percentile":5135.52,"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":"24","median_amount":1691.59,"10th_percentile":1564.04,"90th_percentile":1811.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":931.37,"10th_percentile":931.37,"90th_percentile":931.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"41","median_amount":1188.15,"10th_percentile":1188.15,"90th_percentile":1237.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"32","median_amount":931.37,"10th_percentile":931.37,"90th_percentile":931.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1218.54,"10th_percentile":1218.54,"90th_percentile":1218.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"16","median_amount":1237.55,"10th_percentile":1188.15,"90th_percentile":3449.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":931.37,"10th_percentile":931.37,"90th_percentile":931.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1262.3,"10th_percentile":1211.91,"90th_percentile":2481.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"39","median_amount":1220.0,"10th_percentile":1220.0,"90th_percentile":1729.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":1091.0,"10th_percentile":1091.0,"90th_percentile":1546.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":931.38,"10th_percentile":931.38,"90th_percentile":1456.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"137","median_amount":1843.65,"10th_percentile":1707.89,"90th_percentile":2765.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"59","median_amount":1237.55,"10th_percentile":1188.15,"90th_percentile":1856.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"77","median_amount":1683.42,"10th_percentile":1204.52,"90th_percentile":2285.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1346.72,"10th_percentile":1346.72,"90th_percentile":1814.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"118","median_amount":7398.67,"10th_percentile":6846.35,"90th_percentile":12242.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"233","median_amount":7404.3,"10th_percentile":6842.75,"90th_percentile":11567.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"126","median_amount":1237.55,"10th_percentile":1188.15,"90th_percentile":1856.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":1642.47,"10th_percentile":1188.15,"90th_percentile":1843.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":1714.59,"10th_percentile":1143.06,"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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"486","median_amount":7398.12,"10th_percentile":6826.09,"90th_percentile":11964.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"63","median_amount":2560.25,"10th_percentile":2277.54,"90th_percentile":3077.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":1204.52,"10th_percentile":1204.52,"90th_percentile":1967.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1115.82,"10th_percentile":1115.82,"90th_percentile":1115.82,"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":"176","median_amount":1237.55,"10th_percentile":1188.15,"90th_percentile":1856.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1626.11,"10th_percentile":1626.11,"90th_percentile":2168.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"158","median_amount":1204.52,"10th_percentile":1204.52,"90th_percentile":1819.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1683.42,"10th_percentile":1204.52,"90th_percentile":2285.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"71","median_amount":1237.55,"10th_percentile":1188.15,"90th_percentile":1856.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1209.43,"10th_percentile":963.61,"90th_percentile":1829.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"27","median_amount":1262.3,"10th_percentile":1262.3,"90th_percentile":2049.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"111","median_amount":1729.0,"10th_percentile":1676.21,"90th_percentile":2593.5,"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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"19","median_amount":1546.0,"10th_percentile":1546.0,"90th_percentile":2319.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"78","median_amount":1587.65,"10th_percentile":1204.52,"90th_percentile":2286.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":4874.61,"10th_percentile":4067.64,"90th_percentile":5127.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2824.92,"10th_percentile":1806.05,"90th_percentile":2824.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2828.98,"10th_percentile":2828.98,"90th_percentile":2828.98,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":11362.01,"10th_percentile":10474.83,"90th_percentile":18708.54,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":11703.71,"10th_percentile":11578.31,"90th_percentile":13521.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":2544.19,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2858.72,"10th_percentile":2858.72,"90th_percentile":2858.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"20","median_amount":10907.25,"10th_percentile":8940.87,"90th_percentile":13455.17,"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":3886.08,"10th_percentile":3575.41,"90th_percentile":4398.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2712.15,"10th_percentile":1733.96,"90th_percentile":2824.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3043.75,"10th_percentile":3043.75,"90th_percentile":3043.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1806.05,"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":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2665.76,"10th_percentile":2665.76,"90th_percentile":2665.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":3624.0,"10th_percentile":3460.05,"90th_percentile":3624.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3171.99,"10th_percentile":3171.99,"90th_percentile":3171.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex GI Procedures","code_information":[{"code":"5331","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6084.22,"10th_percentile":6084.22,"90th_percentile":6084.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6089.13,"10th_percentile":6089.13,"90th_percentile":6089.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5341","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":5759.94,"10th_percentile":5759.94,"90th_percentile":8324.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1251.08,"10th_percentile":1251.08,"90th_percentile":1251.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5690.41,"10th_percentile":5690.41,"90th_percentile":5690.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":22362.33,"10th_percentile":22362.33,"90th_percentile":22362.33,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":41044.27,"10th_percentile":41044.27,"90th_percentile":41044.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":4425.0,"10th_percentile":4298.65,"90th_percentile":5417.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3834.36,"10th_percentile":3834.36,"90th_percentile":3834.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3571.35,"10th_percentile":3571.35,"90th_percentile":3571.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":26173.15,"10th_percentile":17432.76,"90th_percentile":36479.16,"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":7950.28,"10th_percentile":5910.78,"90th_percentile":16490.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3610.72,"10th_percentile":3610.72,"90th_percentile":3610.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5417.98,"10th_percentile":5417.98,"90th_percentile":5417.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"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":3766.45,"10th_percentile":3607.98,"90th_percentile":6400.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5417.98,"10th_percentile":4475.46,"90th_percentile":5417.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4513.5,"10th_percentile":4513.5,"90th_percentile":4513.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":5426.0,"10th_percentile":5272.72,"90th_percentile":8627.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3605.19,"10th_percentile":3605.19,"90th_percentile":3772.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":9990.06,"10th_percentile":9990.06,"90th_percentile":9990.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":43497.54,"10th_percentile":43497.54,"90th_percentile":43497.54,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":33842.42,"10th_percentile":33842.42,"90th_percentile":33842.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":5417.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6665.84,"10th_percentile":6665.84,"90th_percentile":6665.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":42702.82,"10th_percentile":42702.82,"90th_percentile":42702.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":6000.13,"10th_percentile":6000.13,"90th_percentile":6000.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5417.98,"10th_percentile":5417.98,"90th_percentile":5417.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"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":6228.33,"10th_percentile":6228.33,"90th_percentile":6228.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5417.98,"10th_percentile":5417.98,"90th_percentile":5417.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6507.35,"10th_percentile":6507.35,"90th_percentile":6507.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"52","median_amount":9101.86,"10th_percentile":6997.51,"90th_percentile":10626.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"23","median_amount":5201.7,"10th_percentile":4311.64,"90th_percentile":7661.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":5967.21,"10th_percentile":5843.02,"90th_percentile":5993.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4364.67,"10th_percentile":4364.67,"90th_percentile":4364.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"62","median_amount":41148.65,"10th_percentile":27299.01,"90th_percentile":51216.26,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"53","median_amount":38838.51,"10th_percentile":28313.64,"90th_percentile":57369.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"66","median_amount":5201.7,"10th_percentile":4311.64,"90th_percentile":7751.95,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6081.85,"10th_percentile":6011.55,"90th_percentile":6345.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6007.64,"10th_percentile":6007.64,"90th_percentile":6007.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"165","median_amount":38095.04,"10th_percentile":26660.7,"90th_percentile":52025.09,"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":"27","median_amount":12962.26,"10th_percentile":9272.14,"90th_percentile":17418.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5788.71,"10th_percentile":5788.71,"90th_percentile":5941.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"87","median_amount":5417.98,"10th_percentile":4188.53,"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":"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":5963.21,"10th_percentile":5813.21,"90th_percentile":6341.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4768.89,"10th_percentile":4768.89,"90th_percentile":4768.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"32","median_amount":5381.09,"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":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5064.51,"10th_percentile":5064.51,"90th_percentile":5470.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"20","median_amount":5951.55,"10th_percentile":4513.5,"90th_percentile":8139.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"43","median_amount":7612.36,"10th_percentile":5988.65,"90th_percentile":15547.9,"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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":6803.0,"10th_percentile":4817.79,"90th_percentile":12723.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":5956.32,"10th_percentile":4768.58,"90th_percentile":6318.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":16279.29,"10th_percentile":15517.31,"90th_percentile":16279.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6.04,"10th_percentile":6.04,"90th_percentile":6.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10682.0,"10th_percentile":10651.02,"90th_percentile":11022.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":71395.47,"10th_percentile":57120.01,"90th_percentile":89618.42,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":68848.97,"10th_percentile":47003.24,"90th_percentile":73128.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":7016.18,"10th_percentile":13.17,"90th_percentile":8153.95,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10988.2,"10th_percentile":10988.2,"90th_percentile":10988.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"16","median_amount":66695.85,"10th_percentile":45040.13,"90th_percentile":87334.64,"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":21577.99,"10th_percentile":20008.8,"90th_percentile":25761.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7859.91,"10th_percentile":1757.62,"90th_percentile":9124.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[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":11009.23,"10th_percentile":11009.23,"90th_percentile":11230.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7307.91,"10th_percentile":7105.11,"90th_percentile":7313.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7454.07,"10th_percentile":7454.07,"90th_percentile":7454.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":10792.4,"10th_percentile":8636.5,"90th_percentile":11418.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":6803.51,"10th_percentile":6803.51,"90th_percentile":6803.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11022.0,"10th_percentile":11022.0,"90th_percentile":11022.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Urology and Related Services","code_information":[{"code":"5371","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":850.27,"10th_percentile":850.27,"90th_percentile":850.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1945.41,"10th_percentile":1945.41,"90th_percentile":1945.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":372.99,"10th_percentile":372.99,"90th_percentile":372.99,"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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 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":13390.66,"10th_percentile":13390.66,"90th_percentile":13390.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":304.27,"10th_percentile":304.27,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":287.74,"10th_percentile":287.74,"90th_percentile":287.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"11","median_amount":1043.67,"10th_percentile":565.68,"90th_percentile":2836.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":837.08,"10th_percentile":681.86,"90th_percentile":839.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":3493.36,"10th_percentile":1749.6,"90th_percentile":3493.36,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":14554.3,"10th_percentile":14554.3,"90th_percentile":14554.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":874.67,"10th_percentile":551.73,"90th_percentile":1103.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":695.78,"10th_percentile":695.78,"90th_percentile":2135.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"57","median_amount":1592.83,"10th_percentile":1181.29,"90th_percentile":3375.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":999.32,"10th_percentile":626.62,"90th_percentile":1126.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"27","median_amount":689.86,"10th_percentile":681.86,"90th_percentile":2092.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1013.46,"10th_percentile":1013.46,"90th_percentile":1013.46,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":729.0,"10th_percentile":434.0,"90th_percentile":1170.35,"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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":840.49,"10th_percentile":684.65,"90th_percentile":2095.57,"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":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Urology and Related Services","code_information":[{"code":"5373","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":3203.12,"10th_percentile":3203.12,"90th_percentile":3561.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2137.83,"10th_percentile":2137.83,"90th_percentile":2220.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2092.7,"10th_percentile":1725.2,"90th_percentile":6870.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":13242.43,"10th_percentile":13242.43,"90th_percentile":13242.43,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":13616.53,"10th_percentile":11023.67,"90th_percentile":27098.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":2404.26,"10th_percentile":2404.26,"90th_percentile":2525.88,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2135.41,"10th_percentile":1885.41,"90th_percentile":2135.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1985.93,"10th_percentile":1985.93,"90th_percentile":1998.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":19521.39,"10th_percentile":5437.01,"90th_percentile":28273.25,"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":5598.42,"10th_percentile":4424.24,"90th_percentile":7338.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1353.94,"10th_percentile":1353.94,"90th_percentile":1353.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2199.74,"10th_percentile":2199.74,"90th_percentile":2199.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":2095.7,"10th_percentile":1945.7,"90th_percentile":2096.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2137.83,"10th_percentile":1899.47,"90th_percentile":3597.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2101.24,"10th_percentile":2101.24,"90th_percentile":2101.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2180.59,"10th_percentile":2180.59,"90th_percentile":2180.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":3488.18,"10th_percentile":3488.18,"90th_percentile":3488.18,"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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2072.71,"10th_percentile":1725.21,"90th_percentile":2101.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":5392.92,"10th_percentile":4074.34,"90th_percentile":10599.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1955.3,"10th_percentile":1955.3,"90th_percentile":1955.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3523.37,"10th_percentile":3193.86,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2818.7,"10th_percentile":2818.7,"90th_percentile":3309.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":19708.17,"10th_percentile":15486.33,"90th_percentile":27318.04,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"17","median_amount":19746.65,"10th_percentile":14276.22,"90th_percentile":30695.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":3128.92,"10th_percentile":3128.92,"90th_percentile":3128.92,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3595.28,"10th_percentile":3595.28,"90th_percentile":3595.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3343.61,"10th_percentile":3343.61,"90th_percentile":3343.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"28","median_amount":23402.49,"10th_percentile":14375.55,"90th_percentile":31172.17,"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":8677.27,"10th_percentile":7826.29,"90th_percentile":10436.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3406.01,"10th_percentile":3406.01,"90th_percentile":3406.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1877.25,"10th_percentile":570.4,"90th_percentile":2137.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":3376.37,"10th_percentile":3103.49,"90th_percentile":3531.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2662.92,"10th_percentile":2662.92,"90th_percentile":2662.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":1955.3,"10th_percentile":1955.3,"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":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2818.7,"10th_percentile":2818.7,"90th_percentile":2818.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":5386.0,"10th_percentile":3624.0,"90th_percentile":7612.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":2390.4,"10th_percentile":2390.4,"90th_percentile":2390.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3528.08,"10th_percentile":3136.28,"90th_percentile":3531.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Urology and Related Services","code_information":[{"code":"5375","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":7951.16,"10th_percentile":5564.88,"90th_percentile":9802.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5117.88,"10th_percentile":5091.53,"90th_percentile":7637.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5193.28,"10th_percentile":5193.28,"90th_percentile":5830.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5214.48,"10th_percentile":5214.48,"90th_percentile":5214.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":33151.43,"10th_percentile":27476.73,"90th_percentile":36605.46,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"11","median_amount":33824.63,"10th_percentile":26170.46,"90th_percentile":43452.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":5349.21,"10th_percentile":4888.28,"90th_percentile":7894.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5299.27,"10th_percentile":5299.27,"90th_percentile":5299.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4928.32,"10th_percentile":4928.32,"90th_percentile":4928.32,"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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"31","median_amount":30062.84,"10th_percentile":22334.1,"90th_percentile":40238.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":9936.12,"10th_percentile":9936.12,"90th_percentile":9936.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6169.3,"10th_percentile":6169.3,"90th_percentile":6169.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4888.28,"10th_percentile":257.68,"90th_percentile":5349.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[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":5196.28,"10th_percentile":4743.53,"90th_percentile":6198.11,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5349.21,"10th_percentile":5091.53,"90th_percentile":5809.55,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5349.21,"10th_percentile":5349.21,"90th_percentile":5349.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5636.82,"10th_percentile":5636.82,"90th_percentile":5636.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":6359.0,"10th_percentile":6359.0,"90th_percentile":9137.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":3238.86,"10th_percentile":3238.86,"90th_percentile":3238.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5091.53,"10th_percentile":4154.64,"90th_percentile":5953.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Urology and Related Services","code_information":[{"code":"5376","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":13640.4,"10th_percentile":13640.4,"90th_percentile":14459.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9103.62,"10th_percentile":9103.62,"90th_percentile":9464.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":55773.28,"10th_percentile":55773.28,"90th_percentile":60364.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":55653.22,"10th_percentile":55653.22,"90th_percentile":56689.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":5541.53,"10th_percentile":5541.53,"90th_percentile":5541.53,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9639.41,"10th_percentile":9639.41,"90th_percentile":9639.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"11","median_amount":56233.15,"10th_percentile":19269.99,"90th_percentile":59795.76,"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":22593.15,"10th_percentile":22593.15,"90th_percentile":22593.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9345.46,"10th_percentile":9345.46,"90th_percentile":9453.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8256.96,"10th_percentile":8256.96,"90th_percentile":8256.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9446.62,"10th_percentile":9299.62,"90th_percentile":9465.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":6359.0,"10th_percentile":6359.0,"90th_percentile":6359.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9485.18,"10th_percentile":9485.18,"90th_percentile":9485.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":58980.86,"10th_percentile":58980.86,"90th_percentile":58980.86,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20570.76,"10th_percentile":20570.76,"90th_percentile":20570.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2704.85,"10th_percentile":2570.97,"90th_percentile":2704.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"1 through 10","median_amount":2566.85,"10th_percentile":2566.85,"90th_percentile":2566.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3662.1,"10th_percentile":3662.1,"90th_percentile":3662.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2616.65,"10th_percentile":2616.65,"90th_percentile":2706.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Gynecologic Procedures","code_information":[{"code":"5411","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"28","median_amount":314.55,"10th_percentile":229.55,"90th_percentile":396.25,"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":"52","median_amount":243.04,"10th_percentile":233.34,"90th_percentile":486.08,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"75","median_amount":864.0,"10th_percentile":694.66,"90th_percentile":1585.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"242","median_amount":243.04,"10th_percentile":233.34,"90th_percentile":243.04,"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":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":233.34,"10th_percentile":233.34,"90th_percentile":233.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"133","median_amount":864.0,"10th_percentile":803.7,"90th_percentile":1596.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"34","median_amount":302.4,"10th_percentile":272.16,"90th_percentile":545.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"275","median_amount":243.04,"10th_percentile":233.34,"90th_percentile":243.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"66","median_amount":243.04,"10th_percentile":243.04,"90th_percentile":369.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":189.18,"10th_percentile":189.18,"90th_percentile":189.18,"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":"72","median_amount":247.9,"10th_percentile":238.01,"90th_percentile":247.9,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"21","median_amount":285.0,"10th_percentile":228.0,"90th_percentile":890.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"11","median_amount":260.0,"10th_percentile":260.0,"90th_percentile":760.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":243.04,"10th_percentile":243.04,"90th_percentile":243.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Gynecologic Procedures","code_information":[{"code":"5412","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":548.77,"10th_percentile":548.77,"90th_percentile":548.77,"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] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":10894.16,"10th_percentile":10894.16,"90th_percentile":10894.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":724.51,"10th_percentile":724.51,"90th_percentile":724.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":11082.98,"10th_percentile":11082.98,"90th_percentile":11082.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1172.56,"10th_percentile":1172.56,"90th_percentile":1172.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":305.8,"10th_percentile":305.8,"90th_percentile":305.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":1029.22,"10th_percentile":1029.22,"90th_percentile":1029.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Gynecologic Procedures","code_information":[{"code":"5413","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":466.15,"10th_percentile":466.15,"90th_percentile":466.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":2289.0,"10th_percentile":2289.0,"90th_percentile":2289.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Gynecologic Procedures","code_information":[{"code":"5414","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"13","median_amount":4609.53,"10th_percentile":3488.17,"90th_percentile":4972.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[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":2918.62,"10th_percentile":2109.46,"90th_percentile":3213.69,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2918.62,"10th_percentile":2918.62,"90th_percentile":2918.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"19","median_amount":14337.42,"10th_percentile":11835.13,"90th_percentile":21079.44,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"14","median_amount":13858.45,"10th_percentile":11330.0,"90th_percentile":22005.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"41","median_amount":2918.62,"10th_percentile":2084.78,"90th_percentile":3059.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3082.4,"10th_percentile":3082.4,"90th_percentile":3082.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"52","median_amount":15149.21,"10th_percentile":10751.69,"90th_percentile":21744.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"12","median_amount":4454.01,"10th_percentile":2440.5,"90th_percentile":5684.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"72","median_amount":2802.11,"10th_percentile":2171.47,"90th_percentile":3489.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3101.12,"10th_percentile":3101.12,"90th_percentile":3254.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"21","median_amount":2918.62,"10th_percentile":2802.11,"90th_percentile":3466.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2918.62,"10th_percentile":2918.62,"90th_percentile":2918.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2858.15,"10th_percentile":2383.23,"90th_percentile":2976.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"12","median_amount":3624.0,"10th_percentile":2561.72,"90th_percentile":3624.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":3238.0,"10th_percentile":3238.0,"90th_percentile":3238.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2598.57,"10th_percentile":2598.57,"90th_percentile":2598.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 5 Gynecologic Procedures","code_information":[{"code":"5415","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":7718.78,"10th_percentile":2879.31,"90th_percentile":9189.51,"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":"1 through 10","median_amount":3489.2,"10th_percentile":3489.2,"90th_percentile":3489.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":18211.55,"10th_percentile":17108.27,"90th_percentile":47391.91,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":19435.57,"10th_percentile":17958.45,"90th_percentile":40668.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":5168.72,"10th_percentile":2802.11,"90th_percentile":8329.94,"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":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"15","median_amount":18565.62,"10th_percentile":14726.2,"90th_percentile":26045.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":6685.67,"10th_percentile":6685.67,"90th_percentile":6685.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"17","median_amount":4962.39,"10th_percentile":2918.62,"90th_percentile":5739.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5046.22,"10th_percentile":5046.22,"90th_percentile":5046.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5510.19,"10th_percentile":5510.19,"90th_percentile":5510.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":5055.64,"10th_percentile":5055.64,"90th_percentile":5055.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":7501.74,"10th_percentile":7501.74,"90th_percentile":7501.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5048.32,"10th_percentile":5048.32,"90th_percentile":5063.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Gynecologic Procedures","code_information":[{"code":"5416","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":52084.76,"10th_percentile":52084.76,"90th_percentile":52084.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3849.02,"10th_percentile":3849.02,"90th_percentile":3849.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6030.36,"10th_percentile":6030.36,"90th_percentile":6030.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7554.33,"10th_percentile":7554.33,"90th_percentile":7554.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"19","median_amount":3053.42,"10th_percentile":1803.42,"90th_percentile":3054.46,"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":1690.8,"10th_percentile":1606.85,"90th_percentile":3928.37,"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":"[APC ($): FEE SCHEDULE]","count":"44","median_amount":1994.9,"10th_percentile":1651.9,"90th_percentile":2002.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2003.04,"10th_percentile":1595.91,"90th_percentile":2003.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"32","median_amount":14383.35,"10th_percentile":10029.24,"90th_percentile":15608.71,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"37","median_amount":14408.68,"10th_percentile":9426.13,"90th_percentile":15131.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":1690.8,"10th_percentile":1623.31,"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":"13","median_amount":2035.61,"10th_percentile":1890.61,"90th_percentile":2035.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":1893.12,"10th_percentile":1732.52,"90th_percentile":1893.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"91","median_amount":13592.02,"10th_percentile":8778.88,"90th_percentile":15407.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":4105.59,"10th_percentile":2550.73,"90th_percentile":5175.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":1823.4,"10th_percentile":1654.16,"90th_percentile":1999.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1623.31,"10th_percentile":1623.31,"90th_percentile":1623.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2374.61,"10th_percentile":2374.61,"90th_percentile":2374.61,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"97","median_amount":1994.9,"10th_percentile":1750.63,"90th_percentile":2002.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2003.04,"10th_percentile":2003.04,"90th_percentile":2003.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2314.05,"10th_percentile":1623.31,"90th_percentile":3381.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2003.04,"10th_percentile":2003.04,"90th_percentile":2003.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2458.48,"10th_percentile":2360.33,"90th_percentile":3229.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"18","median_amount":3876.6,"10th_percentile":2678.28,"90th_percentile":5436.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":3464.6,"10th_percentile":3464.6,"90th_percentile":4857.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, 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 ($): FEE SCHEDULE]","count":"51","median_amount":1833.57,"10th_percentile":1595.93,"90th_percentile":2003.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nerve Procedures","code_information":[{"code":"5432","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":5758.94,"10th_percentile":5758.94,"90th_percentile":5758.94,"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":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":26223.4,"10th_percentile":26223.4,"90th_percentile":26223.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5758.94,"10th_percentile":5758.94,"90th_percentile":5758.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":8137.81,"10th_percentile":8137.81,"90th_percentile":8137.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Injections","code_information":[{"code":"5441","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"13","median_amount":475.61,"10th_percentile":353.42,"90th_percentile":2404.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":300.31,"10th_percentile":300.31,"90th_percentile":300.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"32","median_amount":439.14,"10th_percentile":135.96,"90th_percentile":1358.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":245.01,"10th_percentile":245.01,"90th_percentile":245.01,"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] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"33","median_amount":1685.06,"10th_percentile":1368.99,"90th_percentile":5788.09,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"26","median_amount":1611.66,"10th_percentile":1445.5,"90th_percentile":13363.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":463.71,"10th_percentile":309.14,"90th_percentile":751.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":446.85,"10th_percentile":353.59,"90th_percentile":461.57,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":415.57,"10th_percentile":415.57,"90th_percentile":420.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"97","median_amount":1632.21,"10th_percentile":1052.85,"90th_percentile":13287.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":787.23,"10th_percentile":70.12,"90th_percentile":5063.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":283.53,"10th_percentile":3.45,"90th_percentile":1196.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":636.03,"10th_percentile":463.71,"90th_percentile":1041.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"55","median_amount":434.09,"10th_percentile":290.52,"90th_percentile":596.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":302.79,"10th_percentile":302.79,"90th_percentile":302.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":439.31,"10th_percentile":439.31,"90th_percentile":439.31,"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":"0","additional_payer_notes":"No services performed 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"18","median_amount":492.13,"10th_percentile":396.48,"90th_percentile":1024.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":438.8,"10th_percentile":434.0,"90th_percentile":464.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"41","median_amount":439.72,"10th_percentile":241.25,"90th_percentile":595.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":1096.89,"10th_percentile":1082.85,"90th_percentile":3047.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages 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":500.96,"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 ($): FEE SCHEDULE]","count":"21","median_amount":709.63,"10th_percentile":364.46,"90th_percentile":719.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":740.73,"10th_percentile":740.73,"90th_percentile":740.73,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"22","median_amount":13001.94,"10th_percentile":1626.58,"90th_percentile":13428.51,"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":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"19","median_amount":13326.18,"10th_percentile":13219.94,"90th_percentile":14407.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":959.35,"10th_percentile":714.69,"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":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":721.9,"10th_percentile":350.74,"90th_percentile":1082.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":679.55,"10th_percentile":671.37,"90th_percentile":680.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"55","median_amount":13149.0,"10th_percentile":8396.54,"90th_percentile":14291.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":4707.86,"10th_percentile":3638.74,"90th_percentile":5023.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":729.02,"10th_percentile":729.02,"90th_percentile":729.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":959.35,"10th_percentile":921.05,"90th_percentile":1132.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":641.72,"10th_percentile":398.44,"90th_percentile":955.08,"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 ($): FEE SCHEDULE]","count":"65","median_amount":576.17,"10th_percentile":422.79,"90th_percentile":724.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":959.35,"10th_percentile":751.43,"90th_percentile":7344.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":719.01,"10th_percentile":719.01,"90th_percentile":719.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1644.02,"10th_percentile":1644.02,"90th_percentile":1644.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"12","median_amount":1220.0,"10th_percentile":1100.6,"90th_percentile":1830.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"36","median_amount":576.17,"10th_percentile":477.17,"90th_percentile":723.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Nerve Injections","code_information":[{"code":"5443","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"44","median_amount":1716.57,"10th_percentile":1392.09,"90th_percentile":3130.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1439.02,"10th_percentile":959.35,"90th_percentile":1606.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"58","median_amount":1119.24,"10th_percentile":864.55,"90th_percentile":1379.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1369.81,"10th_percentile":1091.39,"90th_percentile":1379.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"45","median_amount":13234.01,"10th_percentile":10364.88,"90th_percentile":14407.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"47","median_amount":13296.95,"10th_percentile":12322.22,"90th_percentile":14359.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":1439.02,"10th_percentile":959.35,"90th_percentile":2320.62,"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":"21","median_amount":1319.16,"10th_percentile":629.49,"90th_percentile":1400.89,"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 ($): FEE SCHEDULE]","count":"15","median_amount":1294.64,"10th_percentile":863.1,"90th_percentile":1303.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"147","median_amount":13201.5,"10th_percentile":11467.51,"90th_percentile":13622.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":4628.96,"10th_percentile":3519.69,"90th_percentile":5027.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1192.75,"10th_percentile":1136.58,"90th_percentile":1381.57,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"18","median_amount":959.35,"10th_percentile":921.05,"90th_percentile":1439.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1232.82,"10th_percentile":1149.36,"90th_percentile":1241.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"156","median_amount":1227.82,"10th_percentile":912.5,"90th_percentile":1376.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1098.93,"10th_percentile":913.21,"90th_percentile":1378.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1606.85,"10th_percentile":959.35,"90th_percentile":2410.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1369.82,"10th_percentile":913.21,"90th_percentile":1378.48,"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":1467.8,"10th_percentile":1467.8,"90th_percentile":1467.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"23","median_amount":1830.0,"10th_percentile":1285.42,"90th_percentile":1839.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":1636.5,"10th_percentile":1317.6,"90th_percentile":13316.37,"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 ($): FEE SCHEDULE]","count":"59","median_amount":1124.15,"10th_percentile":737.76,"90th_percentile":1379.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Neurostimulator and Related Procedures","code_information":[{"code":"5461","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3520.69,"10th_percentile":3520.69,"90th_percentile":3520.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":18990.5,"10th_percentile":18990.5,"90th_percentile":18990.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":11091.11,"10th_percentile":11091.11,"90th_percentile":11091.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Neurostimulator and Related Procedures","code_information":[{"code":"5462","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":9898.17,"10th_percentile":9898.17,"90th_percentile":9898.17,"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":7760.04,"10th_percentile":7760.04,"90th_percentile":7760.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6711.97,"10th_percentile":6704.47,"90th_percentile":6719.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":33066.37,"10th_percentile":33066.37,"90th_percentile":33116.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":10474.75,"10th_percentile":10474.75,"90th_percentile":10777.76,"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":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":23090.59,"10th_percentile":23090.59,"90th_percentile":25219.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":7420.05,"10th_percentile":7420.05,"90th_percentile":7420.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10474.75,"10th_percentile":8147.86,"90th_percentile":10474.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6707.47,"10th_percentile":6707.47,"90th_percentile":6711.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8570.93,"10th_percentile":8570.93,"90th_percentile":8570.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6712.38,"10th_percentile":6370.77,"90th_percentile":6731.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Neurostimulator and Related Procedures","code_information":[{"code":"5464","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21851.48,"10th_percentile":21851.48,"90th_percentile":21851.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21910.32,"10th_percentile":21910.32,"90th_percentile":21910.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":23695.96,"10th_percentile":23695.96,"90th_percentile":23695.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20419.15,"10th_percentile":20419.15,"90th_percentile":20419.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Neurostimulator and Related Procedures","code_information":[{"code":"5465","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":31130.95,"10th_percentile":31130.95,"90th_percentile":31130.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":115370.19,"10th_percentile":97717.42,"90th_percentile":120225.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":31133.95,"10th_percentile":31133.95,"90th_percentile":31133.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":26028.85,"10th_percentile":26028.85,"90th_percentile":26028.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Implantation of Drug Infusion Device","code_information":[{"code":"5471","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":23430.0,"10th_percentile":23430.0,"90th_percentile":23430.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laser Eye Procedures","code_information":[{"code":"5481","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":857.81,"10th_percentile":686.25,"90th_percentile":857.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":714.59,"10th_percentile":714.59,"90th_percentile":714.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":562.15,"10th_percentile":549.62,"90th_percentile":567.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":562.72,"10th_percentile":562.72,"90th_percentile":562.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":1005.22,"10th_percentile":1005.22,"90th_percentile":1005.22,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":12488.25,"10th_percentile":12488.25,"90th_percentile":12488.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":1265.51,"10th_percentile":1265.51,"90th_percentile":1265.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":571.87,"10th_percentile":571.87,"90th_percentile":571.87,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":531.84,"10th_percentile":531.84,"90th_percentile":531.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":12502.25,"10th_percentile":12502.25,"90th_percentile":12502.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":714.59,"10th_percentile":714.59,"90th_percentile":1229.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":563.43,"10th_percentile":413.43,"90th_percentile":566.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":562.72,"10th_percentile":562.72,"90th_percentile":562.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":714.59,"10th_percentile":714.59,"90th_percentile":714.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":1220.0,"10th_percentile":1220.0,"90th_percentile":1220.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":448.35,"10th_percentile":381.84,"90th_percentile":565.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Intraocular Procedures","code_information":[{"code":"5491","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":3209.6,"10th_percentile":2853.0,"90th_percentile":3566.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"17","median_amount":2143.33,"10th_percentile":2057.77,"90th_percentile":2143.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":2336.93,"10th_percentile":2086.93,"90th_percentile":2337.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2105.29,"10th_percentile":2105.29,"90th_percentile":2105.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":16665.88,"10th_percentile":15834.82,"90th_percentile":17327.22,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"22","median_amount":16281.4,"10th_percentile":15247.58,"90th_percentile":17129.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"33","median_amount":2143.33,"10th_percentile":2082.13,"90th_percentile":2143.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":2377.48,"10th_percentile":2077.48,"90th_percentile":2377.48,"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 ($): FEE SCHEDULE]","count":"12","median_amount":2211.06,"10th_percentile":2211.06,"90th_percentile":2211.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"21","median_amount":16146.6,"10th_percentile":15332.58,"90th_percentile":16774.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":5988.59,"10th_percentile":5988.59,"90th_percentile":5988.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"36","median_amount":2082.13,"10th_percentile":2057.77,"90th_percentile":2143.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"87","median_amount":2317.93,"10th_percentile":2143.33,"90th_percentile":2332.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3883.67,"10th_percentile":3883.67,"90th_percentile":3883.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"17","median_amount":2143.33,"10th_percentile":2143.33,"90th_percentile":2143.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2143.33,"10th_percentile":2143.33,"90th_percentile":2143.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2186.2,"10th_percentile":2186.2,"90th_percentile":2186.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":3447.35,"10th_percentile":3447.35,"90th_percentile":4067.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"19","median_amount":2334.94,"10th_percentile":2082.13,"90th_percentile":2858.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Intraocular Procedures","code_information":[{"code":"5492","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":6290.27,"10th_percentile":6290.27,"90th_percentile":6290.27,"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":3287.7,"10th_percentile":3287.7,"90th_percentile":3287.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3766.64,"10th_percentile":3742.14,"90th_percentile":4109.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3075.58,"10th_percentile":3075.58,"90th_percentile":3075.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":22799.36,"10th_percentile":22799.36,"90th_percentile":33890.13,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":26685.78,"10th_percentile":26685.78,"90th_percentile":26685.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"1 through 10","median_amount":4193.51,"10th_percentile":4193.51,"90th_percentile":4193.51,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":22737.2,"10th_percentile":19557.26,"90th_percentile":36201.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3811.04,"10th_percentile":3766.45,"90th_percentile":4567.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3852.33,"10th_percentile":3697.48,"90th_percentile":4117.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3855.95,"10th_percentile":3855.95,"90th_percentile":3855.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3923.05,"10th_percentile":3923.05,"90th_percentile":3923.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":6359.0,"10th_percentile":6359.0,"90th_percentile":6359.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3722.54,"10th_percentile":3457.39,"90th_percentile":4109.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Intraocular Procedures","code_information":[{"code":"5493","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":2545.71,"10th_percentile":2545.71,"90th_percentile":2545.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":24441.56,"10th_percentile":24441.56,"90th_percentile":24441.56,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5002.08,"10th_percentile":5002.08,"90th_percentile":5002.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":11270.3,"10th_percentile":11270.3,"90th_percentile":11270.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3162.61,"10th_percentile":3162.61,"90th_percentile":3162.61,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5274.01,"10th_percentile":5274.01,"90th_percentile":5279.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3953.58,"10th_percentile":3953.58,"90th_percentile":3953.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[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":3498.53,"10th_percentile":3498.53,"90th_percentile":3498.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":3766.45,"10th_percentile":3766.45,"90th_percentile":3766.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4883.91,"10th_percentile":4883.91,"90th_percentile":4883.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Extraocular, Repair, and Plastic Eye Procedures","code_information":[{"code":"5501","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1622.12,"10th_percentile":1622.12,"90th_percentile":1622.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Extraocular, Repair, and Plastic Eye Procedures","code_information":[{"code":"5503","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2390.58,"10th_percentile":2390.58,"90th_percentile":2390.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":15058.0,"10th_percentile":15058.0,"90th_percentile":15058.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":1844.06,"10th_percentile":1844.06,"90th_percentile":1898.26,"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":2131.92,"10th_percentile":2131.92,"90th_percentile":2131.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2261.69,"10th_percentile":2261.69,"90th_percentile":2261.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":14333.47,"10th_percentile":14333.47,"90th_percentile":15808.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2064.78,"10th_percentile":2064.78,"90th_percentile":2064.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":784.4,"10th_percentile":784.4,"90th_percentile":784.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2062.58,"10th_percentile":1906.63,"90th_percentile":2386.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1265.51,"10th_percentile":1265.51,"90th_percentile":1265.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1906.63,"10th_percentile":1906.63,"90th_percentile":1906.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":3624.0,"10th_percentile":3624.0,"90th_percentile":3624.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2214.58,"10th_percentile":2214.58,"90th_percentile":2214.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"608","median_amount":137.69,"10th_percentile":82.69,"90th_percentile":314.74,"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":"508","median_amount":79.53,"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 ($): FEE SCHEDULE]","count":"451","median_amount":89.95,"10th_percentile":75.25,"90th_percentile":124.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"45","median_amount":71.96,"10th_percentile":71.96,"90th_percentile":223.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"660","median_amount":453.0,"10th_percentile":344.84,"90th_percentile":1076.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"154","median_amount":29.11,"10th_percentile":21.5,"90th_percentile":2078.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","count":"1 through 10","median_amount":771.02,"10th_percentile":670.2,"90th_percentile":1409.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1781","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":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"139","median_amount":91.79,"10th_percentile":91.0,"90th_percentile":124.49,"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 ($): FEE SCHEDULE]","count":"194","median_amount":85.36,"10th_percentile":70.52,"90th_percentile":193.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"2433","median_amount":453.0,"10th_percentile":309.4,"90th_percentile":1076.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"302","median_amount":158.55,"10th_percentile":107.8,"90th_percentile":376.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"54","median_amount":90.45,"10th_percentile":53.97,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":89.95,"10th_percentile":89.95,"90th_percentile":175.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1671","median_amount":70.52,"10th_percentile":67.71,"90th_percentile":220.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":81.36,"10th_percentile":61.36,"90th_percentile":138.36,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"713","median_amount":91.79,"10th_percentile":66.33,"90th_percentile":174.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"49","median_amount":90.32,"10th_percentile":68.74,"90th_percentile":215.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":73.43,"10th_percentile":73.43,"90th_percentile":73.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"903","median_amount":70.52,"10th_percentile":67.71,"90th_percentile":227.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"69","median_amount":71.96,"10th_percentile":70.52,"90th_percentile":216.64,"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":"291","median_amount":71.93,"10th_percentile":69.06,"90th_percentile":231.77,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"522","median_amount":327.0,"10th_percentile":105.78,"90th_percentile":880.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"66","median_amount":290.0,"10th_percentile":165.0,"90th_percentile":786.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"447","median_amount":89.96,"10th_percentile":68.74,"90th_percentile":194.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":256.93,"10th_percentile":70.52,"90th_percentile":355.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1023","median_amount":166.28,"10th_percentile":146.0,"90th_percentile":340.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"765","median_amount":134.01,"10th_percentile":70.52,"90th_percentile":334.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"659","median_amount":108.97,"10th_percentile":103.96,"90th_percentile":302.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"63","median_amount":109.08,"10th_percentile":86.91,"90th_percentile":319.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1046","median_amount":992.0,"10th_percentile":533.0,"90th_percentile":1833.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"141","median_amount":67.16,"10th_percentile":20.0,"90th_percentile":981.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","count":"1 through 10","median_amount":1276.0,"10th_percentile":1276.0,"90th_percentile":1576.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"2586","median_amount":133.34,"10th_percentile":70.52,"90th_percentile":338.78,"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":"243","median_amount":110.85,"10th_percentile":102.64,"90th_percentile":229.69,"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 ($): FEE SCHEDULE]","count":"238","median_amount":103.09,"10th_percentile":103.09,"90th_percentile":291.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"3789","median_amount":1060.64,"10th_percentile":533.0,"90th_percentile":1754.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"453","median_amount":358.75,"10th_percentile":171.5,"90th_percentile":551.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"89","median_amount":109.13,"10th_percentile":73.27,"90th_percentile":287.57,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":108.63,"10th_percentile":108.63,"90th_percentile":225.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"2813","median_amount":131.78,"10th_percentile":70.52,"90th_percentile":334.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"34","median_amount":98.27,"10th_percentile":78.17,"90th_percentile":280.87,"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 ($): FEE SCHEDULE]","count":"1240","median_amount":110.85,"10th_percentile":97.77,"90th_percentile":312.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"73","median_amount":109.08,"10th_percentile":86.91,"90th_percentile":218.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":88.68,"10th_percentile":88.68,"90th_percentile":184.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1378","median_amount":134.01,"10th_percentile":70.52,"90th_percentile":338.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"111","median_amount":109.08,"10th_percentile":104.38,"90th_percentile":222.57,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"454","median_amount":134.42,"10th_percentile":71.93,"90th_percentile":341.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"783","median_amount":630.0,"10th_percentile":206.0,"90th_percentile":880.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"110","median_amount":630.0,"10th_percentile":290.0,"90th_percentile":786.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"632","median_amount":109.14,"10th_percentile":86.91,"90th_percentile":222.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"12","median_amount":133.34,"10th_percentile":121.39,"90th_percentile":334.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"246","median_amount":377.96,"10th_percentile":292.96,"90th_percentile":847.1,"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":"179","median_amount":290.91,"10th_percentile":182.08,"90th_percentile":366.5,"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 ($): FEE SCHEDULE]","count":"241","median_amount":247.69,"10th_percentile":50.93,"90th_percentile":359.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":247.94,"10th_percentile":197.54,"90th_percentile":446.41,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"310","median_amount":3663.0,"10th_percentile":1825.0,"90th_percentile":4442.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"97","median_amount":162.13,"10th_percentile":30.0,"90th_percentile":2016.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"579","median_amount":303.01,"10th_percentile":184.23,"90th_percentile":381.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"74","median_amount":251.97,"10th_percentile":201.97,"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":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"66","median_amount":234.33,"10th_percentile":219.88,"90th_percentile":303.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1153","median_amount":3669.0,"10th_percentile":1873.0,"90th_percentile":4347.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"132","median_amount":1259.69,"10th_percentile":613.55,"90th_percentile":1367.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":250.43,"10th_percentile":81.43,"90th_percentile":290.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"511","median_amount":290.91,"10th_percentile":126.43,"90th_percentile":336.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":222.73,"10th_percentile":26.23,"90th_percentile":226.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"415","median_amount":246.93,"10th_percentile":99.93,"90th_percentile":355.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":247.94,"10th_percentile":232.65,"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":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"270","median_amount":294.36,"10th_percentile":189.65,"90th_percentile":366.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"36","median_amount":247.94,"10th_percentile":247.94,"90th_percentile":251.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"82","median_amount":296.73,"10th_percentile":187.92,"90th_percentile":362.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"224","median_amount":1595.0,"10th_percentile":433.0,"90th_percentile":1671.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"36","median_amount":1427.46,"10th_percentile":564.0,"90th_percentile":1595.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, 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 ($): FEE SCHEDULE]","count":"222","median_amount":246.94,"10th_percentile":99.94,"90th_percentile":290.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":290.91,"10th_percentile":290.91,"90th_percentile":308.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"163","median_amount":857.34,"10th_percentile":643.01,"90th_percentile":873.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"96","median_amount":543.79,"10th_percentile":522.08,"90th_percentile":751.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"213","median_amount":686.03,"10th_percentile":523.13,"90th_percentile":809.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":645.67,"10th_percentile":562.41,"90th_percentile":854.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"154","median_amount":3791.0,"10th_percentile":3166.25,"90th_percentile":5906.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"11","median_amount":126.38,"10th_percentile":25.0,"90th_percentile":1766.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"347","median_amount":543.79,"10th_percentile":522.08,"90th_percentile":889.19,"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":"77","median_amount":571.56,"10th_percentile":571.56,"90th_percentile":823.57,"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 ($): FEE SCHEDULE]","count":"51","median_amount":765.92,"10th_percentile":531.55,"90th_percentile":765.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"547","median_amount":3791.0,"10th_percentile":3291.0,"90th_percentile":5906.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"72","median_amount":1260.51,"10th_percentile":651.88,"90th_percentile":2067.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"31","median_amount":563.63,"10th_percentile":420.0,"90th_percentile":889.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":560.13,"10th_percentile":560.13,"90th_percentile":560.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"236","median_amount":543.79,"10th_percentile":522.08,"90th_percentile":681.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":504.61,"10th_percentile":479.61,"90th_percentile":607.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"431","median_amount":660.1,"10th_percentile":448.1,"90th_percentile":810.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"28","median_amount":645.68,"10th_percentile":514.27,"90th_percentile":826.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"144","median_amount":543.79,"10th_percentile":522.08,"90th_percentile":853.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"28","median_amount":645.68,"10th_percentile":543.79,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":554.67,"10th_percentile":532.52,"90th_percentile":736.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"117","median_amount":527.0,"10th_percentile":375.33,"90th_percentile":869.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"17","median_amount":470.0,"10th_percentile":421.6,"90th_percentile":940.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"218","median_amount":630.32,"10th_percentile":448.11,"90th_percentile":808.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":543.79,"10th_percentile":543.79,"90th_percentile":543.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"55","median_amount":278.36,"10th_percentile":226.5,"90th_percentile":1542.55,"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":"38","median_amount":381.74,"10th_percentile":148.62,"90th_percentile":392.39,"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 ($): FEE SCHEDULE]","count":"57","median_amount":182.6,"10th_percentile":181.86,"90th_percentile":445.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":182.6,"10th_percentile":145.65,"90th_percentile":374.48,"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] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"69","median_amount":3181.0,"10th_percentile":960.0,"90th_percentile":7907.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"27","median_amount":30.0,"10th_percentile":11.2,"90th_percentile":9787.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"114","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":"23","median_amount":185.57,"10th_percentile":177.28,"90th_percentile":453.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":421.83,"10th_percentile":172.58,"90th_percentile":1189.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"247","median_amount":3063.0,"10th_percentile":957.0,"90th_percentile":7912.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"27","median_amount":1016.75,"10th_percentile":291.2,"90th_percentile":2809.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":185.57,"10th_percentile":183.34,"90th_percentile":906.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"125","median_amount":381.74,"10th_percentile":148.62,"90th_percentile":500.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":204.06,"10th_percentile":204.06,"90th_percentile":204.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"144","median_amount":184.86,"10th_percentile":34.86,"90th_percentile":447.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":182.6,"10th_percentile":145.49,"90th_percentile":583.63,"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":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":177.28,"10th_percentile":177.28,"90th_percentile":177.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"71","median_amount":381.74,"10th_percentile":70.52,"90th_percentile":775.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":182.6,"10th_percentile":174.44,"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":"19","median_amount":389.37,"10th_percentile":188.08,"90th_percentile":716.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"39","median_amount":1000.0,"10th_percentile":312.0,"90th_percentile":1065.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":945.0,"10th_percentile":290.0,"90th_percentile":945.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"72","median_amount":182.61,"10th_percentile":145.5,"90th_percentile":558.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"153","median_amount":558.42,"10th_percentile":362.97,"90th_percentile":1271.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"75","median_amount":511.24,"10th_percentile":381.74,"90th_percentile":826.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"119","median_amount":367.64,"10th_percentile":268.83,"90th_percentile":650.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":366.32,"10th_percentile":366.32,"90th_percentile":440.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"197","median_amount":4942.0,"10th_percentile":3490.0,"90th_percentile":8686.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"92","median_amount":215.06,"10th_percentile":18.0,"90th_percentile":4744.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","count":"1 through 10","median_amount":3935.3,"10th_percentile":3935.3,"90th_percentile":3935.3,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"233","median_amount":511.24,"10th_percentile":370.84,"90th_percentile":731.1,"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":"44","median_amount":372.28,"10th_percentile":72.28,"90th_percentile":557.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"31","median_amount":346.22,"10th_percentile":346.22,"90th_percentile":449.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"759","median_amount":4773.99,"10th_percentile":3774.07,"90th_percentile":7727.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"103","median_amount":1746.5,"10th_percentile":1220.8,"90th_percentile":2805.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":368.33,"10th_percentile":168.83,"90th_percentile":1754.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"217","median_amount":490.83,"10th_percentile":370.84,"90th_percentile":714.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":332.35,"10th_percentile":328.35,"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":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"241","median_amount":367.83,"10th_percentile":216.64,"90th_percentile":372.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":366.32,"10th_percentile":366.32,"90th_percentile":368.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":297.82,"10th_percentile":297.82,"90th_percentile":297.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"135","median_amount":511.24,"10th_percentile":366.5,"90th_percentile":579.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":366.32,"10th_percentile":366.32,"90th_percentile":633.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"38","median_amount":521.46,"10th_percentile":481.13,"90th_percentile":777.62,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"149","median_amount":1381.8,"10th_percentile":500.0,"90th_percentile":1671.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"27","median_amount":1491.0,"10th_percentile":703.0,"90th_percentile":1491.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, 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 ($): FEE SCHEDULE]","count":"141","median_amount":365.96,"10th_percentile":217.84,"90th_percentile":464.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Imaging with Contrast","code_information":[{"code":"5573","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":1793.78,"10th_percentile":1793.78,"90th_percentile":1793.78,"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":"1 through 10","median_amount":1071.18,"10th_percentile":1071.18,"90th_percentile":1071.18,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":5596.0,"10th_percentile":5596.0,"90th_percentile":5631.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":5601.0,"10th_percentile":5601.0,"90th_percentile":8774.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":775.19,"10th_percentile":750.74,"90th_percentile":1028.42,"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":934.42,"10th_percentile":934.42,"90th_percentile":934.42,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"17","median_amount":5601.0,"10th_percentile":4545.83,"90th_percentile":8112.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":524.49,"10th_percentile":524.49,"90th_percentile":524.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":635.6,"10th_percentile":635.6,"90th_percentile":635.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1071.18,"10th_percentile":1071.18,"90th_percentile":1351.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":860.88,"10th_percentile":818.73,"90th_percentile":1041.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":486.0,"10th_percentile":437.4,"90th_percentile":1671.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":787.1,"10th_percentile":787.1,"90th_percentile":787.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":643.32,"10th_percentile":628.32,"90th_percentile":22053.04,"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":"11","median_amount":461.46,"10th_percentile":443.03,"90th_percentile":901.37,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":867.46,"10th_percentile":867.46,"90th_percentile":867.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":3893.69,"10th_percentile":2697.02,"90th_percentile":5354.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":22.5,"10th_percentile":22.5,"90th_percentile":22.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":461.46,"10th_percentile":443.03,"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":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":407.95,"10th_percentile":407.95,"90th_percentile":407.95,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":484.22,"10th_percentile":484.22,"90th_percentile":484.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"21","median_amount":3505.0,"10th_percentile":2929.0,"90th_percentile":6840.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":876.4,"10th_percentile":876.4,"90th_percentile":2958.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"17","median_amount":443.03,"10th_percentile":190.87,"90th_percentile":668.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":373.45,"10th_percentile":373.45,"90th_percentile":373.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":424.2,"10th_percentile":219.4,"90th_percentile":864.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":418.08,"10th_percentile":418.08,"90th_percentile":418.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":461.46,"10th_percentile":461.46,"90th_percentile":521.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":421.98,"10th_percentile":421.98,"90th_percentile":421.98,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages 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":552.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":1353.0,"10th_percentile":1005.3,"90th_percentile":1427.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":336.24,"10th_percentile":312.51,"90th_percentile":728.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":856.65,"10th_percentile":850.65,"90th_percentile":1340.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":452.48,"10th_percentile":452.48,"90th_percentile":452.48,"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] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":4163.0,"10th_percentile":3614.0,"90th_percentile":4775.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":3404.0,"10th_percentile":3404.0,"90th_percentile":3404.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":531.98,"10th_percentile":461.46,"90th_percentile":741.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1155.66,"10th_percentile":1155.66,"90th_percentile":1155.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":3122.0,"10th_percentile":3028.0,"90th_percentile":3614.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":1042.65,"10th_percentile":847.84,"90th_percentile":1097.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":461.46,"10th_percentile":461.46,"90th_percentile":461.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":563.58,"10th_percentile":358.78,"90th_percentile":563.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":461.46,"10th_percentile":461.46,"90th_percentile":461.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":1427.0,"10th_percentile":1427.0,"90th_percentile":1427.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":559.68,"10th_percentile":559.68,"90th_percentile":559.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Nuclear Medicine and Related Services","code_information":[{"code":"5593","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"19","median_amount":2041.29,"10th_percentile":1837.16,"90th_percentile":4756.1,"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":"25","median_amount":1313.4,"10th_percentile":1260.97,"90th_percentile":2782.49,"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 ($): FEE SCHEDULE]","count":"46","median_amount":1337.64,"10th_percentile":1137.64,"90th_percentile":2361.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1066.92,"10th_percentile":1066.92,"90th_percentile":1291.63,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"24","median_amount":9920.0,"10th_percentile":9406.5,"90th_percentile":13399.71,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":16795.49,"10th_percentile":45.0,"90th_percentile":35875.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"105","median_amount":1313.4,"10th_percentile":1260.97,"90th_percentile":1883.98,"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":"23","median_amount":1360.86,"10th_percentile":1185.86,"90th_percentile":2760.05,"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 ($): FEE SCHEDULE]","count":"20","median_amount":1265.6,"10th_percentile":1265.6,"90th_percentile":2156.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"65","median_amount":9920.0,"10th_percentile":9350.0,"90th_percentile":13414.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":1532.42,"10th_percentile":1313.4,"90th_percentile":7375.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1317.64,"10th_percentile":1015.14,"90th_percentile":1722.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"44","median_amount":1105.26,"10th_percentile":1061.14,"90th_percentile":2343.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1204.27,"10th_percentile":1204.27,"90th_percentile":2346.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"148","median_amount":1337.54,"10th_percentile":1142.54,"90th_percentile":2330.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1291.63,"10th_percentile":1291.63,"90th_percentile":1712.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2650.05,"10th_percentile":2650.05,"90th_percentile":2650.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"33","median_amount":1313.4,"10th_percentile":1260.97,"90th_percentile":2838.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":1313.4,"10th_percentile":1260.97,"90th_percentile":1348.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1127.37,"10th_percentile":1127.37,"90th_percentile":2393.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":1749.6,"10th_percentile":600.0,"90th_percentile":2707.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":1700.1,"10th_percentile":1265.0,"90th_percentile":1878.5,"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 ($): FEE SCHEDULE]","count":"82","median_amount":1335.43,"10th_percentile":1097.66,"90th_percentile":2704.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Nuclear Medicine and Related Services","code_information":[{"code":"5594","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"12","median_amount":3904.85,"10th_percentile":2350.22,"90th_percentile":9788.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1675.47,"10th_percentile":1613.87,"90th_percentile":1680.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":1812.17,"10th_percentile":1490.05,"90th_percentile":17987.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1496.13,"10th_percentile":1496.13,"90th_percentile":1496.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"19","median_amount":11775.0,"10th_percentile":11395.0,"90th_percentile":22594.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":250.0,"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":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"11","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":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":4078.21,"10th_percentile":1345.46,"90th_percentile":14179.9,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1414.03,"10th_percentile":1414.03,"90th_percentile":12949.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"61","median_amount":12476.78,"10th_percentile":10446.78,"90th_percentile":26556.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":2068.36,"10th_percentile":2068.36,"90th_percentile":3547.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2794.6,"10th_percentile":2794.6,"90th_percentile":2794.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"16","median_amount":1675.47,"10th_percentile":1608.59,"90th_percentile":1680.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"70","median_amount":1495.05,"10th_percentile":1343.05,"90th_percentile":6204.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1496.13,"10th_percentile":1496.13,"90th_percentile":6072.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"23","median_amount":1675.47,"10th_percentile":1627.63,"90th_percentile":1680.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_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":1708.98,"10th_percentile":1684.92,"90th_percentile":1714.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"11","median_amount":3522.0,"10th_percentile":2859.38,"90th_percentile":3525.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":8301.0,"10th_percentile":8301.0,"90th_percentile":8301.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, 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 ($): FEE SCHEDULE]","count":"22","median_amount":1495.06,"10th_percentile":1245.06,"90th_percentile":5125.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5611","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8371.47,"10th_percentile":8371.47,"90th_percentile":8371.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":135.64,"10th_percentile":135.64,"90th_percentile":135.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5612","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":572.4,"10th_percentile":572.4,"90th_percentile":7226.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2054.58,"10th_percentile":2054.58,"90th_percentile":2054.58,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":747.94,"10th_percentile":698.76,"90th_percentile":747.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":299.16,"10th_percentile":299.16,"90th_percentile":299.16,"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] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":5407.0,"10th_percentile":5407.0,"90th_percentile":87563.44,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":351.3,"10th_percentile":234.2,"90th_percentile":2139.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":610.56,"10th_percentile":610.56,"90th_percentile":763.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":27876.0,"10th_percentile":2453.0,"90th_percentile":56492.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":2836.07,"10th_percentile":2836.07,"90th_percentile":2836.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":747.94,"10th_percentile":747.94,"90th_percentile":747.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":337.28,"10th_percentile":224.85,"90th_percentile":15393.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3260.63,"10th_percentile":3260.63,"90th_percentile":3260.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":2939.6,"10th_percentile":373.97,"90th_percentile":5929.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":351.3,"10th_percentile":234.2,"90th_percentile":1985.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":224.85,"10th_percentile":224.85,"90th_percentile":224.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":344.03,"10th_percentile":344.03,"90th_percentile":344.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":956.64,"10th_percentile":956.64,"90th_percentile":956.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":737.0,"10th_percentile":737.0,"90th_percentile":737.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":751.0,"10th_percentile":747.94,"90th_percentile":4470.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5613","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":6285.48,"10th_percentile":6285.48,"90th_percentile":6285.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1922.07,"10th_percentile":1922.07,"90th_percentile":1922.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3486.71,"10th_percentile":3486.71,"90th_percentile":3987.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":15606.0,"10th_percentile":15606.0,"90th_percentile":15606.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":1980.95,"10th_percentile":1980.95,"90th_percentile":1980.95,"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":"1 through 10","median_amount":3291.03,"10th_percentile":3291.03,"90th_percentile":3291.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3084.62,"10th_percentile":3084.62,"90th_percentile":3084.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":28241.0,"10th_percentile":28241.0,"90th_percentile":28241.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2290.65,"10th_percentile":2290.65,"90th_percentile":2290.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2290.65,"10th_percentile":1825.07,"90th_percentile":3285.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2746.84,"10th_percentile":2746.84,"90th_percentile":2746.84,"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":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1687.87,"10th_percentile":1687.87,"90th_percentile":1687.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2767.46,"10th_percentile":2767.46,"90th_percentile":2767.46,"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":"0","additional_payer_notes":"No services performed 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":14103.23,"10th_percentile":14103.23,"90th_percentile":14103.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":2948.0,"10th_percentile":2948.0,"90th_percentile":2948.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3646.71,"10th_percentile":3386.85,"90th_percentile":5794.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Radiation Therapy","code_information":[{"code":"5621","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_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":301.74,"10th_percentile":301.74,"90th_percentile":301.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Radiation Therapy","code_information":[{"code":"5622","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":4527.3,"10th_percentile":3501.27,"90th_percentile":7228.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3544.9,"10th_percentile":3544.9,"90th_percentile":3544.9,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4433.22,"10th_percentile":2235.92,"90th_percentile":5063.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":23879.0,"10th_percentile":16882.64,"90th_percentile":74178.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":13.72,"10th_percentile":13.72,"90th_percentile":13.72,"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":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":3541.0,"10th_percentile":989.87,"90th_percentile":13916.18,"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":"1 through 10","median_amount":3761.29,"10th_percentile":1524.74,"90th_percentile":5346.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1787.12,"10th_percentile":1787.12,"90th_percentile":1787.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"14","median_amount":15750.0,"10th_percentile":7160.0,"90th_percentile":42719.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4079.76,"10th_percentile":4079.76,"90th_percentile":4912.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"13","median_amount":4790.58,"10th_percentile":1880.68,"90th_percentile":11926.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1936.19,"10th_percentile":1936.19,"90th_percentile":1936.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":2919.72,"10th_percentile":672.95,"90th_percentile":5290.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3525.4,"10th_percentile":3525.4,"90th_percentile":3525.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3162.83,"10th_percentile":1827.0,"90th_percentile":4147.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2151.3,"10th_percentile":2151.3,"90th_percentile":2151.3,"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":"1 through 10","median_amount":3072.25,"10th_percentile":690.99,"90th_percentile":4751.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":15811.87,"10th_percentile":8260.0,"90th_percentile":20719.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":5159.0,"10th_percentile":5159.0,"90th_percentile":5159.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3892.3,"10th_percentile":1345.92,"90th_percentile":5855.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Radiation Therapy","code_information":[{"code":"5623","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":10364.92,"10th_percentile":7651.28,"90th_percentile":12587.45,"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":"1 through 10","median_amount":6224.18,"10th_percentile":4292.33,"90th_percentile":6817.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5589.81,"10th_percentile":2499.43,"90th_percentile":6771.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5988.85,"10th_percentile":2644.89,"90th_percentile":6721.61,"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] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":8604.0,"10th_percentile":8604.0,"90th_percentile":8604.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":6087.47,"10th_percentile":5051.02,"90th_percentile":7624.47,"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":"1 through 10","median_amount":5305.22,"10th_percentile":5305.22,"90th_percentile":5637.76,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5865.42,"10th_percentile":5865.42,"90th_percentile":7115.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"15","median_amount":28678.0,"10th_percentile":22866.0,"90th_percentile":43436.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5476.43,"10th_percentile":5476.43,"90th_percentile":5710.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"13","median_amount":6832.0,"10th_percentile":4187.54,"90th_percentile":16985.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"31","median_amount":5611.51,"10th_percentile":3480.67,"90th_percentile":6636.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5644.68,"10th_percentile":5644.68,"90th_percentile":6238.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5971.98,"10th_percentile":386.49,"90th_percentile":6550.64,"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":"0","additional_payer_notes":"No services performed 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":8260.0,"10th_percentile":6065.16,"90th_percentile":11206.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":9950.45,"10th_percentile":8956.9,"90th_percentile":10481.35,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6177.85,"10th_percentile":2635.08,"90th_percentile":6898.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Radiation Therapy","code_information":[{"code":"5626","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":1617.6,"10th_percentile":1617.6,"90th_percentile":1617.6,"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":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2978.57,"10th_percentile":2978.57,"90th_percentile":2978.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Therapeutic Nuclear Medicine","code_information":[{"code":"5661","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":19176.0,"10th_percentile":19176.0,"90th_percentile":19176.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"23","median_amount":83.55,"10th_percentile":66.84,"90th_percentile":257.27,"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":133.0,"10th_percentile":40.49,"90th_percentile":262.01,"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 ($): FEE SCHEDULE]","count":"11","median_amount":54.59,"10th_percentile":54.59,"90th_percentile":54.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"15","median_amount":693.09,"10th_percentile":484.0,"90th_percentile":1822.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":86.02,"10th_percentile":86.02,"90th_percentile":97.36,"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":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":47.57,"10th_percentile":32.06,"90th_percentile":240.05,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":51.8,"10th_percentile":51.8,"90th_percentile":51.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"92","median_amount":484.0,"10th_percentile":410.12,"90th_percentile":1042.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":169.4,"10th_percentile":169.4,"90th_percentile":242.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":32.75,"10th_percentile":32.75,"90th_percentile":32.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"19","median_amount":69.94,"10th_percentile":26.96,"90th_percentile":175.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"23","median_amount":54.59,"10th_percentile":54.59,"90th_percentile":55.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":54.59,"10th_percentile":54.59,"90th_percentile":54.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"13","median_amount":60.74,"10th_percentile":40.49,"90th_percentile":323.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":55.7,"10th_percentile":55.7,"90th_percentile":55.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":72.66,"10th_percentile":72.66,"90th_percentile":72.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"18","median_amount":61.27,"10th_percentile":27.95,"90th_percentile":434.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":32.88,"10th_percentile":32.88,"90th_percentile":32.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":54.59,"10th_percentile":54.59,"90th_percentile":251.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":285.81,"10th_percentile":267.95,"90th_percentile":1207.65,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":175.06,"10th_percentile":170.16,"90th_percentile":624.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":1337.0,"10th_percentile":853.0,"90th_percentile":1782.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":45.0,"10th_percentile":35.0,"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":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":216.93,"10th_percentile":185.76,"90th_percentile":259.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":178.63,"10th_percentile":178.63,"90th_percentile":178.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"32","median_amount":1337.0,"10th_percentile":823.41,"90th_percentile":3134.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":512.14,"10th_percentile":255.26,"90th_percentile":676.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":175.06,"10th_percentile":175.06,"90th_percentile":175.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":415.64,"10th_percentile":415.64,"90th_percentile":415.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":175.06,"10th_percentile":175.06,"90th_percentile":1545.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":319.02,"10th_percentile":319.02,"90th_percentile":319.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":207.0,"10th_percentile":113.64,"90th_percentile":517.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":175.56,"10th_percentile":175.06,"90th_percentile":6684.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"29","median_amount":562.47,"10th_percentile":512.47,"90th_percentile":1383.3,"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":"11","median_amount":242.81,"10th_percentile":231.65,"90th_percentile":414.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":367.48,"10th_percentile":363.58,"90th_percentile":1111.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":293.98,"10th_percentile":293.98,"90th_percentile":293.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"20","median_amount":2580.0,"10th_percentile":641.23,"90th_percentile":5249.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"12","median_amount":45.0,"10th_percentile":30.18,"90th_percentile":45.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":263.1,"10th_percentile":194.72,"90th_percentile":1328.98,"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":"16","median_amount":367.58,"10th_percentile":337.83,"90th_percentile":18468.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":340.0,"10th_percentile":340.0,"90th_percentile":340.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"139","median_amount":2069.7,"10th_percentile":818.0,"90th_percentile":5643.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"17","median_amount":765.8,"10th_percentile":370.48,"90th_percentile":1860.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"14","median_amount":379.6,"10th_percentile":251.77,"90th_percentile":591.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":330.73,"10th_percentile":330.73,"90th_percentile":330.73,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"41","median_amount":367.48,"10th_percentile":367.48,"90th_percentile":1310.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"24","median_amount":340.66,"10th_percentile":233.61,"90th_percentile":9944.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_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":353.94,"10th_percentile":353.94,"90th_percentile":4187.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"27","median_amount":344.99,"10th_percentile":71.9,"90th_percentile":1024.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":839.06,"10th_percentile":78.98,"90th_percentile":12642.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":367.49,"10th_percentile":367.49,"90th_percentile":7714.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Pathology","code_information":[{"code":"5674","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"17","median_amount":1277.33,"10th_percentile":1244.49,"90th_percentile":2416.63,"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":1469.73,"10th_percentile":1332.61,"90th_percentile":1678.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"48","median_amount":1578.86,"10th_percentile":834.52,"90th_percentile":5031.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"11","median_amount":6816.89,"10th_percentile":5813.0,"90th_percentile":10997.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":200.0,"10th_percentile":40.0,"90th_percentile":10271.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":1366.07,"10th_percentile":754.82,"90th_percentile":22997.78,"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":851.55,"10th_percentile":808.16,"90th_percentile":5290.16,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1498.3,"10th_percentile":1498.3,"90th_percentile":1498.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"80","median_amount":7294.0,"10th_percentile":4618.0,"90th_percentile":59850.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":2631.3,"10th_percentile":1669.5,"90th_percentile":4865.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1921.36,"10th_percentile":841.33,"90th_percentile":10477.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"14","median_amount":1252.13,"10th_percentile":923.05,"90th_percentile":2283.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1420.98,"10th_percentile":1420.98,"90th_percentile":1420.98,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"33","median_amount":1578.86,"10th_percentile":1302.78,"90th_percentile":1935.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"13","median_amount":933.97,"10th_percentile":779.84,"90th_percentile":10405.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":811.46,"10th_percentile":811.46,"90th_percentile":10509.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"21","median_amount":721.62,"10th_percentile":217.0,"90th_percentile":2061.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":398.35,"10th_percentile":398.35,"90th_percentile":2101.44,"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 ($): FEE SCHEDULE]","count":"41","median_amount":834.52,"10th_percentile":834.52,"90th_percentile":3387.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":918.54,"10th_percentile":918.54,"90th_percentile":918.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3751.08,"10th_percentile":3751.08,"90th_percentile":3751.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8191.0,"10th_percentile":8191.0,"90th_percentile":8929.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2374.97,"10th_percentile":2374.97,"90th_percentile":2374.97,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":15409.79,"10th_percentile":15409.79,"90th_percentile":28434.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":17905.9,"10th_percentile":17905.9,"90th_percentile":17905.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":3568.27,"10th_percentile":1075.09,"90th_percentile":19847.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9522.93,"10th_percentile":9063.59,"90th_percentile":9570.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2566.85,"10th_percentile":2566.85,"90th_percentile":2566.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"18","median_amount":22220.53,"10th_percentile":10106.42,"90th_percentile":24547.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1690.03,"10th_percentile":1004.25,"90th_percentile":2337.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":5779.86,"10th_percentile":1354.0,"90th_percentile":9557.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2163.88,"10th_percentile":2163.88,"90th_percentile":2163.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2650.05,"10th_percentile":2650.05,"90th_percentile":2650.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2163.25,"10th_percentile":882.42,"90th_percentile":2729.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3443.16,"10th_percentile":3443.16,"90th_percentile":3443.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":5733.6,"10th_percentile":4038.16,"90th_percentile":9400.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":4409.04,"10th_percentile":4409.04,"90th_percentile":4409.04,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12756.03,"10th_percentile":2707.35,"90th_percentile":15613.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"396","median_amount":1510.05,"10th_percentile":111.29,"90th_percentile":6709.55,"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":"158","median_amount":1299.01,"10th_percentile":214.18,"90th_percentile":4188.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1378","median_amount":1698.88,"10th_percentile":73.0,"90th_percentile":6087.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"37","median_amount":73.0,"10th_percentile":58.16,"90th_percentile":1633.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"596","median_amount":6077.2,"10th_percentile":1226.2,"90th_percentile":50535.38,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"152","median_amount":218.17,"10th_percentile":19.03,"90th_percentile":8023.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"480","median_amount":384.18,"10th_percentile":58.17,"90th_percentile":2436.9,"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":"342","median_amount":1558.85,"10th_percentile":74.19,"90th_percentile":7685.31,"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 ($): FEE SCHEDULE]","count":"139","median_amount":1187.75,"10th_percentile":58.17,"90th_percentile":3582.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"2446","median_amount":5783.48,"10th_percentile":865.0,"90th_percentile":46965.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"309","median_amount":763.0,"10th_percentile":89.28,"90th_percentile":5821.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"59","median_amount":1090.19,"10th_percentile":72.71,"90th_percentile":7476.67,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1334.81,"10th_percentile":1334.81,"90th_percentile":1334.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"196","median_amount":1169.27,"10th_percentile":65.45,"90th_percentile":9206.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"38","median_amount":1379.53,"10th_percentile":211.33,"90th_percentile":1626.95,"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 ($): FEE SCHEDULE]","count":"1504","median_amount":1407.35,"10th_percentile":120.53,"90th_percentile":9697.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"127","median_amount":1454.75,"10th_percentile":72.71,"90th_percentile":4079.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"278","median_amount":1174.97,"10th_percentile":58.17,"90th_percentile":8373.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"81","median_amount":1406.36,"10th_percentile":275.3,"90th_percentile":2754.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"40","median_amount":1192.66,"10th_percentile":186.93,"90th_percentile":3832.1,"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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"494","median_amount":1383.51,"10th_percentile":528.16,"90th_percentile":9934.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"66","median_amount":802.0,"10th_percentile":470.0,"90th_percentile":4313.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1085","median_amount":1670.93,"10th_percentile":58.17,"90th_percentile":9672.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":311.48,"10th_percentile":311.48,"90th_percentile":311.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1022","median_amount":329.45,"10th_percentile":230.62,"90th_percentile":2018.16,"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":"482","median_amount":369.92,"10th_percentile":58.17,"90th_percentile":2897.91,"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 ($): FEE SCHEDULE]","count":"1363","median_amount":357.35,"10th_percentile":202.67,"90th_percentile":6702.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":572.02,"10th_percentile":335.02,"90th_percentile":2884.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1187","median_amount":1458.92,"10th_percentile":787.69,"90th_percentile":9647.54,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"203","median_amount":200.54,"10th_percentile":14.97,"90th_percentile":9252.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","count":"1 through 10","median_amount":3683.36,"10th_percentile":3683.36,"90th_percentile":3683.36,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1454","median_amount":491.66,"10th_percentile":84.76,"90th_percentile":4271.41,"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":"[APC ($): FEE SCHEDULE]","count":"280","median_amount":826.86,"10th_percentile":219.63,"90th_percentile":5348.47,"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 ($): FEE SCHEDULE]","count":"273","median_amount":477.63,"10th_percentile":204.26,"90th_percentile":4039.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"4763","median_amount":1329.03,"10th_percentile":706.0,"90th_percentile":7243.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"569","median_amount":439.18,"10th_percentile":218.3,"90th_percentile":2666.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"65","median_amount":349.4,"10th_percentile":141.87,"90th_percentile":5726.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2704.85,"10th_percentile":2704.85,"90th_percentile":2704.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"676","median_amount":369.92,"10th_percentile":56.51,"90th_percentile":1598.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":206.46,"10th_percentile":150.31,"90th_percentile":236.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1498","median_amount":290.86,"10th_percentile":195.64,"90th_percentile":6480.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"70","median_amount":497.89,"10th_percentile":215.24,"90th_percentile":6622.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":702.8,"10th_percentile":702.8,"90th_percentile":878.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"789","median_amount":369.92,"10th_percentile":55.84,"90th_percentile":4648.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"58","median_amount":215.24,"10th_percentile":81.07,"90th_percentile":2163.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"136","median_amount":567.5,"10th_percentile":95.16,"90th_percentile":5996.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1228","median_amount":377.96,"10th_percentile":261.12,"90th_percentile":3565.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"196","median_amount":448.1,"10th_percentile":232.0,"90th_percentile":4025.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1182","median_amount":399.9,"10th_percentile":172.19,"90th_percentile":6970.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":714.59,"10th_percentile":714.59,"90th_percentile":714.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Drug Administration","code_information":[{"code":"5694","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1006","median_amount":8430.0,"10th_percentile":813.36,"90th_percentile":23812.08,"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":"344","median_amount":2182.83,"10th_percentile":369.92,"90th_percentile":13925.16,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1305","median_amount":2834.6,"10th_percentile":458.69,"90th_percentile":18556.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":2177.38,"10th_percentile":346.49,"90th_percentile":23810.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1156","median_amount":19024.15,"10th_percentile":4834.46,"90th_percentile":71076.73,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"243","median_amount":3265.44,"10th_percentile":27.44,"90th_percentile":38669.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"864","median_amount":2162.99,"10th_percentile":439.45,"90th_percentile":13995.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"475","median_amount":4361.48,"10th_percentile":804.11,"90th_percentile":13804.14,"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 ($): FEE SCHEDULE]","count":"147","median_amount":3509.74,"10th_percentile":556.37,"90th_percentile":15368.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"5113","median_amount":29829.9,"10th_percentile":4690.73,"90th_percentile":75841.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"569","median_amount":3845.97,"10th_percentile":878.59,"90th_percentile":24848.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"142","median_amount":1572.19,"10th_percentile":275.21,"90th_percentile":12114.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1058.43,"10th_percentile":1058.43,"90th_percentile":1058.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"336","median_amount":7505.17,"10th_percentile":388.18,"90th_percentile":13914.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2272.76,"10th_percentile":2272.76,"90th_percentile":3458.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1936","median_amount":3818.62,"10th_percentile":482.22,"90th_percentile":15896.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"101","median_amount":2474.61,"10th_percentile":931.88,"90th_percentile":18882.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11380.92,"10th_percentile":11380.92,"90th_percentile":11380.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"493","median_amount":5609.88,"10th_percentile":428.09,"90th_percentile":13925.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"149","median_amount":7028.98,"10th_percentile":578.54,"90th_percentile":11978.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"60","median_amount":754.64,"10th_percentile":377.32,"90th_percentile":11666.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1133","median_amount":5526.52,"10th_percentile":895.28,"90th_percentile":16394.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"209","median_amount":2688.77,"10th_percentile":884.67,"90th_percentile":14112.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1233","median_amount":5245.67,"10th_percentile":369.1,"90th_percentile":15590.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"62","median_amount":244.65,"10th_percentile":214.65,"90th_percentile":244.65,"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":"17","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 ($): FEE SCHEDULE]","count":"24","median_amount":160.33,"10th_percentile":61.84,"90th_percentile":161.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"47","median_amount":1358.0,"10th_percentile":1083.68,"90th_percentile":1358.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":190.64,"10th_percentile":183.03,"90th_percentile":199.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":163.1,"10th_percentile":163.1,"90th_percentile":163.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":151.68,"10th_percentile":151.68,"90th_percentile":151.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"213","median_amount":1358.0,"10th_percentile":1246.0,"90th_percentile":1358.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"25","median_amount":475.3,"10th_percentile":348.88,"90th_percentile":475.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":61.84,"10th_percentile":61.84,"90th_percentile":61.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"75","median_amount":183.03,"10th_percentile":183.03,"90th_percentile":190.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":145.75,"10th_percentile":145.75,"90th_percentile":145.75,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":159.84,"10th_percentile":159.84,"90th_percentile":161.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":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":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"31","median_amount":190.64,"10th_percentile":183.03,"90th_percentile":190.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"14","median_amount":194.45,"10th_percentile":186.69,"90th_percentile":208.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"34","median_amount":294.0,"10th_percentile":268.0,"90th_percentile":294.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":268.0,"10th_percentile":268.0,"90th_percentile":268.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, 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 ($): FEE SCHEDULE]","count":"16","median_amount":160.5,"10th_percentile":127.88,"90th_percentile":163.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":185.2,"10th_percentile":185.2,"90th_percentile":185.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"46","median_amount":486.92,"10th_percentile":365.19,"90th_percentile":486.92,"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":"43","median_amount":228.58,"10th_percentile":199.83,"90th_percentile":238.08,"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 ($): FEE SCHEDULE]","count":"32","median_amount":318.12,"10th_percentile":220.12,"90th_percentile":320.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":254.5,"10th_percentile":237.42,"90th_percentile":254.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"46","median_amount":1709.0,"10th_percentile":1585.18,"90th_percentile":2039.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":95.32,"10th_percentile":95.32,"90th_percentile":95.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"91","median_amount":231.28,"10th_percentile":202.19,"90th_percentile":274.29,"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":"15","median_amount":274.61,"10th_percentile":224.61,"90th_percentile":324.61,"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 ($): FEE SCHEDULE]","count":"25","median_amount":301.89,"10th_percentile":281.65,"90th_percentile":301.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"147","median_amount":1820.76,"10th_percentile":1590.4,"90th_percentile":1979.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"30","median_amount":598.15,"10th_percentile":380.13,"90th_percentile":692.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":318.12,"10th_percentile":308.32,"90th_percentile":322.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"125","median_amount":228.58,"10th_percentile":199.83,"90th_percentile":238.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":286.81,"10th_percentile":286.81,"90th_percentile":286.81,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"66","median_amount":318.12,"10th_percentile":296.79,"90th_percentile":318.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"73","median_amount":208.14,"10th_percentile":199.83,"90th_percentile":238.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":254.5,"10th_percentile":229.31,"90th_percentile":254.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"13","median_amount":212.3,"10th_percentile":203.83,"90th_percentile":242.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"39","median_amount":421.6,"10th_percentile":150.23,"90th_percentile":527.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":470.0,"10th_percentile":158.0,"90th_percentile":527.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, 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 ($): FEE SCHEDULE]","count":"52","median_amount":269.12,"10th_percentile":254.5,"90th_percentile":319.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":208.14,"10th_percentile":208.14,"90th_percentile":208.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Diagnostic Tests and Related Services","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":696.75,"10th_percentile":696.75,"90th_percentile":696.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":494.01,"10th_percentile":494.01,"90th_percentile":494.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":208.14,"10th_percentile":208.14,"90th_percentile":208.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":2787.0,"10th_percentile":2078.43,"90th_percentile":10729.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":471.95,"10th_percentile":471.95,"90th_percentile":471.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Diagnostic Tests and Related Services","code_information":[{"code":"5724","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"30","median_amount":1590.83,"10th_percentile":558.42,"90th_percentile":2149.25,"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":"13","median_amount":964.28,"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 ($): FEE SCHEDULE]","count":"27","median_amount":992.62,"10th_percentile":364.83,"90th_percentile":1042.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"20","median_amount":4863.0,"10th_percentile":4347.82,"90th_percentile":6776.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":953.0,"10th_percentile":471.92,"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":1037.55,"10th_percentile":372.28,"90th_percentile":1432.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":992.62,"10th_percentile":992.62,"90th_percentile":992.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"80","median_amount":4863.0,"10th_percentile":4436.27,"90th_percentile":6770.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":1670.2,"10th_percentile":1039.34,"90th_percentile":2307.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":623.6,"10th_percentile":623.6,"90th_percentile":623.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"42","median_amount":953.0,"10th_percentile":8.01,"90th_percentile":992.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"42","median_amount":1039.74,"10th_percentile":519.67,"90th_percentile":1407.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":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":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":848.44,"10th_percentile":848.44,"90th_percentile":848.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":543.79,"10th_percentile":5.5,"90th_percentile":992.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":1012.47,"90th_percentile":1012.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"14","median_amount":1380.0,"10th_percentile":1043.11,"90th_percentile":1597.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":1188.0,"10th_percentile":1188.0,"90th_percentile":1188.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":992.62,"10th_percentile":831.48,"90th_percentile":1404.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Minor Procedures","code_information":[{"code":"5731","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"34","median_amount":38.3,"10th_percentile":22.98,"90th_percentile":72.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":45.45,"10th_percentile":45.45,"90th_percentile":45.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"29","median_amount":25.02,"10th_percentile":24.02,"90th_percentile":25.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"11","median_amount":174.9,"10th_percentile":148.43,"90th_percentile":186.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":186.0,"10th_percentile":186.0,"90th_percentile":186.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":45.45,"10th_percentile":45.45,"90th_percentile":45.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":25.53,"10th_percentile":25.53,"90th_percentile":25.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"43","median_amount":186.0,"10th_percentile":181.9,"90th_percentile":186.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":65.1,"10th_percentile":65.1,"90th_percentile":65.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"49","median_amount":25.42,"10th_percentile":5.42,"90th_percentile":25.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":45.45,"10th_percentile":43.64,"90th_percentile":45.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":186.0,"10th_percentile":186.0,"90th_percentile":186.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":186.0,"10th_percentile":186.0,"90th_percentile":186.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20.02,"10th_percentile":20.02,"90th_percentile":25.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Minor Procedures","code_information":[{"code":"5732","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"37","median_amount":61.37,"10th_percentile":58.04,"90th_percentile":64.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":77.56,"10th_percentile":74.46,"90th_percentile":171.72,"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 ($): FEE SCHEDULE]","count":"37","median_amount":40.26,"10th_percentile":40.09,"90th_percentile":201.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":40.26,"10th_percentile":40.26,"90th_percentile":40.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"35","median_amount":256.0,"10th_percentile":150.53,"90th_percentile":256.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"95","median_amount":77.56,"10th_percentile":74.46,"90th_percentile":77.56,"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":"14","median_amount":40.91,"10th_percentile":38.69,"90th_percentile":40.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":38.05,"10th_percentile":38.05,"90th_percentile":38.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"110","median_amount":256.0,"10th_percentile":238.08,"90th_percentile":256.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"16","median_amount":89.6,"10th_percentile":80.64,"90th_percentile":89.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":40.09,"10th_percentile":26.54,"90th_percentile":40.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"65","median_amount":74.46,"10th_percentile":74.46,"90th_percentile":77.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":36.58,"10th_percentile":36.58,"90th_percentile":36.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"97","median_amount":40.09,"10th_percentile":20.49,"90th_percentile":40.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":40.09,"10th_percentile":40.09,"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":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"58","median_amount":77.56,"10th_percentile":74.46,"90th_percentile":77.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":40.26,"10th_percentile":40.26,"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":"1 through 10","median_amount":76.85,"10th_percentile":75.95,"90th_percentile":79.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"31","median_amount":256.0,"10th_percentile":204.8,"90th_percentile":256.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":237.0,"10th_percentile":237.0,"90th_percentile":237.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"41","median_amount":40.26,"10th_percentile":37.59,"90th_percentile":40.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"120","median_amount":92.88,"10th_percentile":60.87,"90th_percentile":156.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"74","median_amount":58.17,"10th_percentile":32.28,"90th_percentile":96.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"139","median_amount":60.68,"10th_percentile":19.42,"90th_percentile":61.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":48.55,"10th_percentile":46.28,"90th_percentile":60.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"134","median_amount":330.0,"10th_percentile":321.0,"90th_percentile":1230.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":73.75,"10th_percentile":73.75,"90th_percentile":1836.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","count":"1 through 10","median_amount":330.0,"10th_percentile":330.0,"90th_percentile":330.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"273","median_amount":53.65,"10th_percentile":31.36,"90th_percentile":117.37,"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":"31","median_amount":61.92,"10th_percentile":18.33,"90th_percentile":127.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":57.59,"10th_percentile":54.89,"90th_percentile":230.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"436","median_amount":330.0,"10th_percentile":307.23,"90th_percentile":1230.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"52","median_amount":115.5,"10th_percentile":112.35,"90th_percentile":478.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":36.41,"10th_percentile":14.56,"90th_percentile":80.53,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":60.68,"10th_percentile":60.68,"90th_percentile":60.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"176","median_amount":52.73,"10th_percentile":31.0,"90th_percentile":131.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":32.28,"10th_percentile":30.12,"90th_percentile":55.12,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"214","median_amount":60.93,"10th_percentile":41.08,"90th_percentile":242.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":60.68,"10th_percentile":60.68,"90th_percentile":110.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"127","median_amount":58.17,"10th_percentile":31.0,"90th_percentile":122.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":58.08,"10th_percentile":48.55,"90th_percentile":60.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":53.11,"10th_percentile":31.62,"90th_percentile":134.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"113","median_amount":267.0,"10th_percentile":213.6,"90th_percentile":343.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":290.0,"10th_percentile":237.0,"90th_percentile":336.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"114","median_amount":57.84,"10th_percentile":23.14,"90th_percentile":61.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":109.48,"10th_percentile":82.02,"90th_percentile":402.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"221","median_amount":166.22,"10th_percentile":31.25,"90th_percentile":262.47,"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":"93","median_amount":34.98,"10th_percentile":18.26,"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 ($): FEE SCHEDULE]","count":"326","median_amount":126.78,"10th_percentile":23.52,"90th_percentile":133.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":70.41,"10th_percentile":20.41,"90th_percentile":105.35,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"282","median_amount":702.0,"10th_percentile":347.0,"90th_percentile":1556.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"23","median_amount":30.0,"10th_percentile":18.19,"90th_percentile":187.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"252","median_amount":100.37,"10th_percentile":19.74,"90th_percentile":160.84,"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":"114","median_amount":123.25,"10th_percentile":25.03,"90th_percentile":134.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"62","median_amount":122.46,"10th_percentile":34.94,"90th_percentile":190.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1081","median_amount":675.85,"10th_percentile":347.0,"90th_percentile":1492.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"155","median_amount":201.95,"10th_percentile":103.6,"90th_percentile":513.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"30","median_amount":131.68,"10th_percentile":31.6,"90th_percentile":134.32,"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":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"167","median_amount":39.9,"10th_percentile":9.01,"90th_percentile":138.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":118.51,"10th_percentile":22.93,"90th_percentile":130.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"513","median_amount":131.68,"10th_percentile":23.69,"90th_percentile":132.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":131.68,"10th_percentile":34.42,"90th_percentile":161.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"135","median_amount":39.08,"10th_percentile":14.51,"90th_percentile":131.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"37","median_amount":105.35,"10th_percentile":25.49,"90th_percentile":131.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":50.96,"10th_percentile":24.58,"90th_percentile":143.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"219","median_amount":217.0,"10th_percentile":28.25,"90th_percentile":460.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"36","median_amount":285.14,"10th_percentile":28.25,"90th_percentile":617.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"360","median_amount":131.69,"10th_percentile":24.28,"90th_percentile":134.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Electronic Analysis of Devices","code_information":[{"code":"5741","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"22","median_amount":54.42,"10th_percentile":3.31,"90th_percentile":58.31,"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":"33","median_amount":45.45,"10th_percentile":43.64,"90th_percentile":45.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"113","median_amount":38.21,"10th_percentile":38.09,"90th_percentile":38.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":38.25,"10th_percentile":30.48,"90th_percentile":38.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"23","median_amount":385.0,"10th_percentile":273.1,"90th_percentile":385.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"101","median_amount":45.45,"10th_percentile":43.64,"90th_percentile":45.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"59","median_amount":38.87,"10th_percentile":36.38,"90th_percentile":38.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"55","median_amount":36.15,"10th_percentile":36.15,"90th_percentile":36.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"85","median_amount":385.0,"10th_percentile":287.1,"90th_percentile":385.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"17","median_amount":107.8,"10th_percentile":45.45,"90th_percentile":134.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":38.4,"10th_percentile":38.4,"90th_percentile":38.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":38.09,"10th_percentile":38.09,"90th_percentile":38.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":65.32,"10th_percentile":65.32,"90th_percentile":65.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":34.28,"10th_percentile":34.28,"90th_percentile":34.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"275","median_amount":38.49,"10th_percentile":18.49,"90th_percentile":38.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":38.09,"10th_percentile":38.09,"90th_percentile":38.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":31.1,"10th_percentile":31.1,"90th_percentile":31.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"53","median_amount":45.45,"10th_percentile":43.64,"90th_percentile":45.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":38.25,"10th_percentile":38.25,"90th_percentile":38.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":46.36,"10th_percentile":44.51,"90th_percentile":46.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":385.0,"10th_percentile":30.48,"90th_percentile":385.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"133","median_amount":38.25,"10th_percentile":30.48,"90th_percentile":38.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Electronic Analysis of Devices","code_information":[{"code":"5743","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":110.18,"10th_percentile":110.18,"90th_percentile":110.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Rehabilitation","code_information":[{"code":"5771","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"65","median_amount":1181.28,"10th_percentile":350.0,"90th_percentile":2362.56,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"69","median_amount":874.58,"10th_percentile":258.04,"90th_percentile":1414.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1129.05,"10th_percentile":1129.05,"90th_percentile":1129.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"116","median_amount":2450.0,"10th_percentile":700.0,"90th_percentile":3850.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":350.0,"10th_percentile":350.0,"90th_percentile":350.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"23","median_amount":810.0,"10th_percentile":405.0,"90th_percentile":1312.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":488.24,"10th_percentile":244.12,"90th_percentile":1342.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"160","median_amount":2100.0,"10th_percentile":700.0,"90th_percentile":4200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"28","median_amount":857.5,"10th_percentile":367.5,"90th_percentile":1418.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":257.24,"10th_percentile":257.24,"90th_percentile":257.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"145","median_amount":874.58,"10th_percentile":249.88,"90th_percentile":1414.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":926.1,"10th_percentile":308.7,"90th_percentile":1234.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":617.4,"10th_percentile":102.9,"90th_percentile":1131.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"46","median_amount":1190.0,"10th_percentile":178.0,"90th_percentile":1780.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":690.0,"10th_percentile":690.0,"90th_percentile":690.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, 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 ($): FEE SCHEDULE]","count":"83","median_amount":900.41,"10th_percentile":257.26,"90th_percentile":1543.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Resuscitation and Cardioversion","code_information":[{"code":"5781","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":1023.21,"10th_percentile":1023.21,"90th_percentile":1880.55,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":670.5,"10th_percentile":668.5,"90th_percentile":1228.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":4390.67,"10th_percentile":3559.72,"90th_percentile":24380.79,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":1269.19,"10th_percentile":1269.19,"90th_percentile":1284.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1253.7,"10th_percentile":1253.7,"90th_percentile":1253.7,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":634.39,"10th_percentile":634.39,"90th_percentile":1165.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":6271.56,"10th_percentile":4937.2,"90th_percentile":21898.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":747.11,"10th_percentile":747.11,"90th_percentile":747.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":668.9,"10th_percentile":648.9,"90th_percentile":1230.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1321.96,"10th_percentile":1321.96,"90th_percentile":1321.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":793.73,"10th_percentile":793.73,"90th_percentile":793.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":928.0,"10th_percentile":928.0,"90th_percentile":928.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":644.0,"10th_percentile":644.0,"90th_percentile":644.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":554.02,"10th_percentile":554.02,"90th_percentile":879.77,"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":"11","median_amount":260.62,"10th_percentile":215.53,"90th_percentile":406.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":160.37,"10th_percentile":160.37,"90th_percentile":160.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":355.71,"10th_percentile":355.71,"90th_percentile":355.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":2975.12,"10th_percentile":1436.64,"90th_percentile":4727.57,"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":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":3229.28,"10th_percentile":2379.0,"90th_percentile":4825.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":260.62,"10th_percentile":166.67,"90th_percentile":394.67,"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":10214.08,"10th_percentile":476.51,"90th_percentile":13739.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":727.02,"10th_percentile":727.02,"90th_percentile":727.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"26","median_amount":2917.42,"10th_percentile":1750.87,"90th_percentile":4436.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":1073.99,"10th_percentile":1073.99,"90th_percentile":1073.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"38","median_amount":293.09,"10th_percentile":198.58,"90th_percentile":468.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":252.87,"10th_percentile":207.78,"90th_percentile":9851.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":282.07,"10th_percentile":282.07,"90th_percentile":282.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"15","median_amount":252.87,"10th_percentile":215.53,"90th_percentile":454.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":250.22,"10th_percentile":250.22,"90th_percentile":250.22,"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":"13","median_amount":258.24,"10th_percentile":250.56,"90th_percentile":599.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":898.4,"10th_percentile":139.6,"90th_percentile":1123.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventilation Initiation and Management","code_information":[{"code":"5801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2505.4,"10th_percentile":2505.4,"90th_percentile":2505.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Platelet pheres leukoreduced","code_information":[{"code":"9501","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":1687.25,"10th_percentile":1687.25,"90th_percentile":1687.25,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1847.96,"10th_percentile":923.98,"90th_percentile":2325.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":50264.06,"10th_percentile":50264.06,"90th_percentile":50264.06,"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":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":1405.38,"10th_percentile":1405.38,"90th_percentile":1405.38,"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":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":4998.25,"10th_percentile":4202.35,"90th_percentile":66064.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":2055.36,"10th_percentile":925.88,"90th_percentile":4342.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1918.52,"10th_percentile":1918.52,"90th_percentile":1918.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_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":871.01,"10th_percentile":871.01,"90th_percentile":871.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":1923.43,"10th_percentile":1923.43,"90th_percentile":1923.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":923.98,"10th_percentile":627.07,"90th_percentile":1055.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Platelet pheresis irradiated","code_information":[{"code":"9502","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":1102.56,"10th_percentile":1102.56,"90th_percentile":1102.56,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1488.44,"10th_percentile":1237.76,"90th_percentile":4324.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":106789.92,"10th_percentile":106789.92,"90th_percentile":106789.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":15.23,"10th_percentile":15.23,"90th_percentile":15.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":6344.83,"10th_percentile":6344.83,"90th_percentile":16988.98,"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":1043.38,"10th_percentile":1043.38,"90th_percentile":1043.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1022.51,"10th_percentile":1022.51,"90th_percentile":1022.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":14264.25,"10th_percentile":14264.25,"90th_percentile":14264.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"RBC deglycerolized","code_information":[{"code":"9504","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":3207.76,"10th_percentile":3207.76,"90th_percentile":3207.76,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Platelets, pheresis","code_information":[{"code":"9507","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4523.58,"10th_percentile":4523.58,"90th_percentile":4523.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":17891.41,"10th_percentile":17891.41,"90th_percentile":17891.41,"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":"[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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6597.28,"10th_percentile":3015.72,"90th_percentile":26935.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Plasma 1 donor frz w/in 8 hr","code_information":[{"code":"9508","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":4797.96,"10th_percentile":4797.96,"90th_percentile":4797.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"RBC leukocytes reduced","code_information":[{"code":"9512","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":981.72,"10th_percentile":981.72,"90th_percentile":981.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1125.91,"10th_percentile":1125.91,"90th_percentile":1125.91,"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":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed 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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":799.84,"10th_percentile":799.84,"90th_percentile":799.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red blood cells unit","code_information":[{"code":"9517","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":27671.2,"10th_percentile":27671.2,"90th_percentile":27671.2,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"RBC leukoreduced irradiated","code_information":[{"code":"9522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":1451.0,"10th_percentile":1451.0,"90th_percentile":1451.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":947.99,"10th_percentile":795.18,"90th_percentile":1523.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":5128.0,"10th_percentile":5128.0,"90th_percentile":5128.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":4465.83,"10th_percentile":4465.83,"90th_percentile":4465.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":727.4,"10th_percentile":727.4,"90th_percentile":727.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":9508.49,"10th_percentile":9508.49,"90th_percentile":20750.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":3262.05,"10th_percentile":3262.05,"90th_percentile":3262.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":947.99,"10th_percentile":947.99,"90th_percentile":947.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":858.68,"10th_percentile":858.68,"90th_percentile":858.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Plate pheres leukoredu irrad","code_information":[{"code":"9530","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":9098.6,"10th_percentile":5093.88,"90th_percentile":39937.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":2373.98,"10th_percentile":1177.56,"90th_percentile":4538.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":7053.13,"10th_percentile":135.0,"90th_percentile":20157.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":853.93,"10th_percentile":853.93,"90th_percentile":853.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"25","median_amount":16183.36,"10th_percentile":5715.64,"90th_percentile":90767.36,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":654.88,"10th_percentile":654.88,"90th_percentile":654.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2440.06,"10th_percentile":2440.06,"90th_percentile":2440.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":2764.37,"10th_percentile":1419.07,"90th_percentile":4998.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3791.58,"10th_percentile":3791.58,"90th_percentile":3791.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":851.29,"10th_percentile":851.29,"90th_percentile":851.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":414.28,"10th_percentile":414.28,"90th_percentile":414.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":3304.59,"10th_percentile":2182.98,"90th_percentile":5293.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Platelets pheresis path redu","code_information":[{"code":"9536","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":15764.69,"10th_percentile":15764.69,"90th_percentile":15764.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":20023.52,"10th_percentile":20023.52,"90th_percentile":20023.52,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":828.48,"10th_percentile":828.48,"90th_percentile":828.48,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1043.01,"10th_percentile":1043.01,"90th_percentile":1043.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":289.18,"10th_percentile":289.18,"90th_percentile":289.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":32036.0,"10th_percentile":32036.0,"90th_percentile":32036.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-OPPS Clinic Services","code_information":[{"code":"N700","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"52","median_amount":99.29,"10th_percentile":45.65,"90th_percentile":220.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"29","median_amount":170.53,"10th_percentile":135.09,"90th_percentile":270.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"239","median_amount":131.65,"10th_percentile":92.45,"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":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":132.19,"10th_percentile":125.5,"90th_percentile":264.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"146","median_amount":259.0,"10th_percentile":192.62,"90th_percentile":722.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"88","median_amount":35.99,"10th_percentile":8.83,"90th_percentile":52.88,"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":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":174.37,"10th_percentile":135.09,"90th_percentile":604.2,"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 ($): FEE SCHEDULE]","count":"61","median_amount":134.34,"10th_percentile":53.74,"90th_percentile":134.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"98","median_amount":124.94,"10th_percentile":118.61,"90th_percentile":132.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"485","median_amount":259.0,"10th_percentile":140.0,"90th_percentile":414.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"37","median_amount":90.65,"10th_percentile":49.0,"90th_percentile":144.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":440.22,"10th_percentile":440.22,"90th_percentile":440.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"87","median_amount":190.55,"10th_percentile":140.0,"90th_percentile":365.9,"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":"[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":"338","median_amount":131.65,"10th_percentile":124.99,"90th_percentile":131.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":131.65,"10th_percentile":124.99,"90th_percentile":658.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"53","median_amount":180.99,"10th_percentile":135.09,"90th_percentile":426.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":132.19,"10th_percentile":125.5,"90th_percentile":134.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"17","median_amount":181.74,"10th_percentile":166.99,"90th_percentile":373.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"98","median_amount":158.25,"10th_percentile":85.54,"90th_percentile":252.95,"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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"11","median_amount":172.91,"10th_percentile":158.25,"90th_percentile":188.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"202","median_amount":131.66,"10th_percentile":105.33,"90th_percentile":210.66,"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":"1 through 10","median_amount":215.53,"10th_percentile":215.53,"90th_percentile":215.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"2051","median_amount":76.8,"10th_percentile":23.39,"90th_percentile":252.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1516","median_amount":36.3,"10th_percentile":11.86,"90th_percentile":134.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"3067","median_amount":39.67,"10th_percentile":17.42,"90th_percentile":116.19,"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 ($): FEE SCHEDULE]","count":"99","median_amount":57.59,"10th_percentile":21.26,"90th_percentile":138.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"2234","median_amount":410.0,"10th_percentile":108.0,"90th_percentile":1133.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"512","median_amount":26.61,"10th_percentile":8.83,"90th_percentile":247.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","count":"1 through 10","median_amount":226.0,"10th_percentile":226.0,"90th_percentile":554.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"6615","median_amount":36.52,"10th_percentile":11.72,"90th_percentile":105.06,"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 ($): FEE SCHEDULE]","count":"908","median_amount":46.12,"10th_percentile":17.2,"90th_percentile":128.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"689","median_amount":44.85,"10th_percentile":17.48,"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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"9935","median_amount":421.0,"10th_percentile":157.02,"90th_percentile":1211.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1199","median_amount":131.95,"10th_percentile":47.25,"90th_percentile":407.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"198","median_amount":42.71,"10th_percentile":18.89,"90th_percentile":115.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":26.62,"10th_percentile":16.52,"90th_percentile":100.14,"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":"3823","median_amount":37.88,"10th_percentile":12.0,"90th_percentile":143.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"153","median_amount":53.01,"10th_percentile":24.18,"90th_percentile":118.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"4933","median_amount":44.58,"10th_percentile":18.15,"90th_percentile":131.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"317","median_amount":47.45,"10th_percentile":18.97,"90th_percentile":178.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":33.46,"10th_percentile":33.46,"90th_percentile":63.11,"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":"2853","median_amount":36.23,"10th_percentile":11.72,"90th_percentile":112.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"256","median_amount":44.89,"10th_percentile":18.97,"90th_percentile":123.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"795","median_amount":40.58,"10th_percentile":11.92,"90th_percentile":121.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"2208","median_amount":67.0,"10th_percentile":21.13,"90th_percentile":217.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"320","median_amount":54.79,"10th_percentile":9.19,"90th_percentile":217.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"2528","median_amount":47.27,"10th_percentile":18.99,"90th_percentile":131.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"15","median_amount":91.38,"10th_percentile":13.8,"90th_percentile":579.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"464","median_amount":255.58,"10th_percentile":109.88,"90th_percentile":558.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"385","median_amount":181.08,"10th_percentile":45.27,"90th_percentile":396.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"516","median_amount":181.37,"10th_percentile":72.64,"90th_percentile":403.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"36","median_amount":174.96,"10th_percentile":90.44,"90th_percentile":268.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"444","median_amount":827.0,"10th_percentile":222.0,"90th_percentile":1835.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"515","median_amount":80.0,"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":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":"1163","median_amount":387.72,"10th_percentile":99.78,"90th_percentile":898.02,"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 ($): FEE SCHEDULE]","count":"164","median_amount":175.92,"10th_percentile":74.4,"90th_percentile":369.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"78","median_amount":181.08,"10th_percentile":69.19,"90th_percentile":324.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1636","median_amount":828.0,"10th_percentile":180.0,"90th_percentile":1877.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"201","median_amount":289.1,"10th_percentile":69.93,"90th_percentile":593.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"43","median_amount":202.03,"10th_percentile":73.62,"90th_percentile":303.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":251.31,"10th_percentile":251.31,"90th_percentile":251.31,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1249","median_amount":181.08,"10th_percentile":45.27,"90th_percentile":554.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":97.18,"10th_percentile":65.62,"90th_percentile":315.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1050","median_amount":150.32,"10th_percentile":71.78,"90th_percentile":341.45,"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 ($): FEE SCHEDULE]","count":"69","median_amount":177.56,"10th_percentile":75.83,"90th_percentile":333.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"681","median_amount":181.08,"10th_percentile":45.27,"90th_percentile":419.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"108","median_amount":182.87,"10th_percentile":86.92,"90th_percentile":296.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"198","median_amount":184.72,"10th_percentile":46.18,"90th_percentile":427.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"341","median_amount":249.2,"10th_percentile":70.0,"90th_percentile":712.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"49","median_amount":452.0,"10th_percentile":158.0,"90th_percentile":1106.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"510","median_amount":158.81,"10th_percentile":59.54,"90th_percentile":352.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":328.53,"10th_percentile":328.53,"90th_percentile":328.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"454","median_amount":173.72,"10th_percentile":166.85,"90th_percentile":178.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"243","median_amount":89.96,"10th_percentile":86.37,"90th_percentile":89.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"256","median_amount":113.49,"10th_percentile":113.49,"90th_percentile":116.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":139.79,"10th_percentile":139.79,"90th_percentile":139.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"451","median_amount":534.0,"10th_percentile":534.0,"90th_percentile":534.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"28","median_amount":115.81,"10th_percentile":115.81,"90th_percentile":534.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","count":"1 through 10","median_amount":534.0,"10th_percentile":534.0,"90th_percentile":534.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"789","median_amount":89.96,"10th_percentile":86.37,"90th_percentile":89.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"79","median_amount":115.81,"10th_percentile":115.81,"90th_percentile":115.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"100","median_amount":107.7,"10th_percentile":87.39,"90th_percentile":107.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1729","median_amount":534.0,"10th_percentile":534.0,"90th_percentile":534.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"272","median_amount":186.9,"10th_percentile":186.9,"90th_percentile":186.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"40","median_amount":113.49,"10th_percentile":98.79,"90th_percentile":114.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":113.49,"10th_percentile":113.49,"90th_percentile":116.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"874","median_amount":86.37,"10th_percentile":86.37,"90th_percentile":89.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":102.14,"10th_percentile":102.14,"90th_percentile":102.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"634","median_amount":113.49,"10th_percentile":113.49,"90th_percentile":113.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"28","median_amount":113.49,"10th_percentile":113.49,"90th_percentile":113.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":115.81,"10th_percentile":115.81,"90th_percentile":115.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"389","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 ($): FEE SCHEDULE]","count":"42","median_amount":113.49,"10th_percentile":113.49,"90th_percentile":116.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"129","median_amount":91.76,"10th_percentile":88.1,"90th_percentile":91.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"382","median_amount":175.0,"10th_percentile":167.0,"90th_percentile":175.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"65","median_amount":156.0,"10th_percentile":156.0,"90th_percentile":167.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"277","median_amount":113.51,"10th_percentile":113.51,"90th_percentile":113.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":183.77,"10th_percentile":183.77,"90th_percentile":575.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":283.26,"10th_percentile":283.26,"90th_percentile":283.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":150.48,"10th_percentile":116.99,"90th_percentile":320.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"1 through 10","median_amount":972.0,"10th_percentile":646.0,"90th_percentile":1588.53,"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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":200.0,"10th_percentile":200.0,"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":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":399.12,"10th_percentile":399.12,"90th_percentile":923.67,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":190.32,"10th_percentile":132.98,"90th_percentile":211.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"11","median_amount":694.0,"10th_percentile":512.15,"90th_percentile":1234.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":416.7,"10th_percentile":416.7,"90th_percentile":723.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":315.41,"10th_percentile":315.41,"90th_percentile":373.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":150.48,"10th_percentile":41.75,"90th_percentile":292.46,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":343.88,"10th_percentile":343.88,"90th_percentile":343.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":157.39,"10th_percentile":157.39,"90th_percentile":157.39,"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":195.57,"10th_percentile":42.97,"90th_percentile":216.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Observation, Other","code_information":[{"code":"N811","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1180.29,"10th_percentile":1180.29,"90th_percentile":1180.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":1725.0,"10th_percentile":1725.0,"90th_percentile":1725.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":2005.0,"10th_percentile":2005.0,"90th_percentile":2005.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1757.62,"10th_percentile":1757.62,"90th_percentile":1757.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"0","additional_payer_notes":"No services performed during 15-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 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"20","median_amount":255.74,"10th_percentile":167.25,"90th_percentile":325.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":87.39,"10th_percentile":38.33,"90th_percentile":89.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"24","median_amount":654.0,"10th_percentile":523.0,"90th_percentile":654.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":86.37,"10th_percentile":37.23,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":111.5,"10th_percentile":61.5,"90th_percentile":111.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":86.37,"10th_percentile":81.53,"90th_percentile":107.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"91","median_amount":537.0,"10th_percentile":523.0,"90th_percentile":654.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":228.9,"10th_percentile":183.05,"90th_percentile":393.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":109.27,"10th_percentile":109.27,"90th_percentile":109.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"37","median_amount":86.37,"10th_percentile":86.37,"90th_percentile":89.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":98.34,"10th_percentile":98.34,"90th_percentile":98.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":109.27,"10th_percentile":85.92,"90th_percentile":109.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"20","median_amount":87.39,"10th_percentile":36.8,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":128.71,"10th_percentile":128.71,"90th_percentile":128.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"12","median_amount":88.1,"10th_percentile":37.54,"90th_percentile":91.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"20","median_amount":167.0,"10th_percentile":116.9,"90th_percentile":195.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":156.0,"10th_percentile":156.0,"90th_percentile":156.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":109.27,"10th_percentile":109.27,"90th_percentile":124.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"1 through 10","median_amount":1110.0,"10th_percentile":1110.0,"90th_percentile":1110.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1203.73,"10th_percentile":1203.73,"90th_percentile":1203.73,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":1703.98,"10th_percentile":1703.98,"90th_percentile":1703.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","count":"1 through 10","median_amount":1362.45,"10th_percentile":1362.45,"90th_percentile":1362.45,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":414.39,"10th_percentile":414.39,"90th_percentile":3029.45,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"1 through 10","median_amount":1362.45,"10th_percentile":1362.45,"90th_percentile":3807.31,"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":"1 through 10","median_amount":653.52,"10th_percentile":653.52,"90th_percentile":653.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3029.45,"10th_percentile":3029.45,"90th_percentile":3029.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":422.68,"10th_percentile":422.68,"90th_percentile":422.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"1 through 10","median_amount":486.0,"10th_percentile":486.0,"90th_percentile":1163.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":1308.0,"10th_percentile":1308.0,"90th_percentile":1308.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"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] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30]","count":"20","median_amount":379.96,"10th_percentile":48.75,"90th_percentile":741.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":490.83,"10th_percentile":490.83,"90th_percentile":511.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":365.95,"10th_percentile":364.83,"90th_percentile":368.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":366.32,"10th_percentile":366.32,"90th_percentile":366.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP High Cost Drugs (%BC): 19] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 30.50]","count":"47","median_amount":2427.71,"10th_percentile":195.0,"90th_percentile":2522.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for 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): 29.94] [Observation (%BC): 29.94] [Emergency Department (%BC): 29.94] [Occupational Therapy (%BC): 29.94] [Physical Therapy (%BC): 29.94] [Respiratory Services/Therapy  (%BC): 29.94] [Speech Therapy (%BC): 29.94] [OP High Cost Drugs (%BC): 35.35] [All Other OP (%BC): 29.94]","count":"20","median_amount":40.0,"10th_percentile":16.8,"90th_percentile":105.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 31.5] [Observation (%BC): 31.5 Maximum Reimbursement 6750] [Emergency Department (%BC): 31.5 Maximum Reimbursement 6750] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 27 Maximum Reimbursement 153] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 26.95]","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":490.83,"10th_percentile":190.65,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":372.28,"10th_percentile":372.28,"90th_percentile":372.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","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): 35] [Observation (%BC): 35 Maximum Reimbursement 7500] [Emergency Department (%BC): 35 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Mental Health (%BC): 30 Maximum Reimbursement 170] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 29.94]","count":"176","median_amount":390.0,"10th_percentile":195.0,"90th_percentile":2482.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in 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":731.43,"10th_percentile":68.25,"90th_percentile":812.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"12","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":"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":364.83,"10th_percentile":364.83,"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":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":511.24,"10th_percentile":490.83,"90th_percentile":511.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":500.65,"10th_percentile":500.65,"90th_percentile":521.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1729] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 48626] [Insertion of Permanent Pacemaker ($): 17682] [PTCA w/ Drug Eluting Stent ($): 15854] [PTCA w/non Drug Eluting Stent ($): 11718] [PTCA w/out stent ($): 11443] [Stereotactic Radiosurgery ($): 19288] [Stereotactic Radiosurgery-Fractionated ($): 9300] [Observation ($): 2394] [Emergency Department ($): 1123] [Urgent Care ($): 277] [Cardiac Rehabilitation Therapy ($): 178] [Cardiac Stress Test ($): 527] [Cardiology ($): 705] [Echocardiology ($): 527] [EKG/ECG ($): 267] [Electrophysiology Ablation ($): 6513] [Electrophysiology and Mapping Studies ($): 3982] [Holter Monitor/Telemetry ($): 273] [Peripheral Vascular Lab ($): 433] [EEG ($): 346] [EMG ($): 253] [MEG ($): 771] [Neuropsychological Testing and Biofeedback ($): 219] [Sleep Studies-Attended ($): 1380] [Sleep Studies-Unattended ($): 294] [Chemotherapy ($): 527] [Nuclear Medicine ($): 1417] [Oncology ($): 522] [Radiation Therapy ($): 826] [CT Scan OP ($): 1059] [MRI OP ($): 1671] [Imaging Services ($): 354] [Mammography-Diagnostic ($): 175] [Mammography-Screening ($): 175] [Positron Emission Tomography ($): 3522] [Radiology ($): 327] [Ultrasound Imaging ($): 705] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 705] [Peritoneal Dialysis, CAPD, and CCPD ($): 705] [Occupational Therapy ($): 178] [Physical Therapy ($): 178] [Resp. Services/Therapy ($): 175] [Speech Therapy ($): 178] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1762] [IV Therapy ($): 132] [Pulmonary Function ($): 178] [Pulmonary Rehabilitation ($): 158]","count":"35","median_amount":1671.0,"10th_percentile":195.0,"90th_percentile":1671.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1546] [Insertion of Automatic Implantable Cardiac Defibrillator (AICD) ($): 43451] [Insertion of Permanent Pacemaker ($): 15801] [PTCA w/ Drug Eluting Stent ($): 14167] [PTCA w/non Drug Eluting Stent ($): 10473] [PTCA w/out stent ($): 10224] [Stereotactic Radiosurgery ($): 17235] [Stereotactic Radiosurgery-Fractionated ($): 8311] [Observation ($): 2139] [Emergency Department ($): 1003] [Urgent Care ($): 249] [Cardiac Rehabilitation Therapy ($): 158] [Cardiac Stress Test ($): 470] [Cardiology ($): 630] [Echocardiology ($): 470] [EKG/ECG ($): 237] [Electrophysiology Ablation ($): 5821] [Electrophysiology and Mapping Studies ($): 3560] [Holter Monitor/Telemetry ($): 243] [Peripheral Vascular Lab ($): 394] [EEG ($): 316] [EMG ($): 231] [MEG ($): 691] [Neuropsychological Testing and Biofeedback ($): 198] [Sleep Studies-Attended ($): 1257] [Sleep Studies-Unattended ($): 268] [Chemotherapy ($): 470] [Nuclear Medicine ($): 1265] [Oncology ($): 466] [Radiation Therapy ($): 737] [CT Scan OP ($): 945] [MRI OP ($): 1491] [Imaging Services ($): 316] [Mammography-Diagnostic ($): 156] [Mammography-Screening ($): 156] [Positron Emission Tomography ($): 3146] [Radiology ($): 290] [Ultrasound Imaging ($): 630] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 630] [Peritoneal Dialysis, CAPD, and CCPD ($): 630] [Occupational Therapy ($): 158] [Physical Therapy ($): 158] [Resp. Services/Therapy ($): 156] [Speech Therapy ($): 158] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Hyperbarics ($): 1575] [IV Therapy ($): 119] [Pulmonary Function ($): 158] [Pulmonary Rehabilitation ($): 145]","count":"1 through 10","median_amount":195.0,"10th_percentile":195.0,"90th_percentile":290.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":291.87,"10th_percentile":291.87,"90th_percentile":369.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone marrow transplant","code_information":[{"code":"009","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyphema","code_information":[{"code":"043","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections","code_information":[{"code":"044","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological eye disorders","code_information":[{"code":"045","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w CC","code_information":[{"code":"046","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w/o CC","code_information":[{"code":"047","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age 0-17","code_information":[{"code":"048","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures","code_information":[{"code":"049","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sialoadenectomy","code_information":[{"code":"050","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures Except Sialoadenectomy","code_information":[{"code":"051","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","code_information":[{"code":"104","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass w PTCA","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"109","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w CC","code_information":[{"code":"110","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w/o CC","code_information":[{"code":"111","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"112","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement","code_information":[{"code":"118","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein ligation & stripping","code_information":[{"code":"119","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other circulatory system O.R. procedures","code_information":[{"code":"120","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute & Subacute Endocarditis","code_information":[{"code":"126","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure & Shock","code_information":[{"code":"127","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis","code_information":[{"code":"128","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W Cc/Mcc Or Major Device","code_information":[{"code":"129","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W/O Cc/Mcc","code_information":[{"code":"130","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W Cc/Mcc","code_information":[{"code":"131","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W/O Cc/Mcc","code_information":[{"code":"132","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","code_information":[{"code":"133","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","code_information":[{"code":"134","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","code_information":[{"code":"160","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w CC","code_information":[{"code":"161","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","code_information":[{"code":"162","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures w/o CC","code_information":[{"code":"169","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures w/o CC","code_information":[{"code":"171","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"G.I. hemorrhage w CC","code_information":[{"code":"174","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":104337.31,"maximum":156505.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":156505.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104337.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104337.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":109658.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104337.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104337.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104337.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104337.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104337.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104337.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104337.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104337.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104337.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104337.31,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w CC","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","code_information":[{"code":"222","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","code_information":[{"code":"223","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","code_information":[{"code":"224","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","code_information":[{"code":"225","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","code_information":[{"code":"226","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","code_information":[{"code":"227","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other cardiothoracic procedures w/o CC/MCC","code_information":[{"code":"230","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w MCC","code_information":[{"code":"237","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w/o MCC","code_information":[{"code":"238","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"246","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","code_information":[{"code":"247","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"248","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","code_information":[{"code":"249","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy Without Intraluminal Device","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"1 through 10","median_amount":74662.64,"10th_percentile":74662.64,"90th_percentile":74662.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":23451.27,"maximum":35176.90,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35176.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23451.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23451.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24647.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23451.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23451.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23451.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23451.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23451.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23451.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23451.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23451.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23451.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23451.27,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Mcc","code_information":[{"code":"338","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Cc","code_information":[{"code":"339","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"340","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Mcc","code_information":[{"code":"341","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Cc","code_information":[{"code":"342","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"343","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","code_information":[{"code":"359","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":23379.45,"maximum":35069.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35069.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23379.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23379.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24571.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23379.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23379.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23379.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23379.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23379.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23379.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23379.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23379.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23379.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23379.45,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endoscopic Tubal Interruption","code_information":[{"code":"362","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization & Radio-Implant, for Malignancy","code_information":[{"code":"363","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization Except for Malignancy","code_information":[{"code":"364","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures","code_information":[{"code":"365","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, female reproductive system w CC","code_information":[{"code":"366","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System w/o CC","code_information":[{"code":"367","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Age 0-17","code_information":[{"code":"396","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"400","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w other O.R. proc w CC","code_information":[{"code":"401","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w CC","code_information":[{"code":"403","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & Non-Acute Leukemia w/o CC","code_information":[{"code":"404","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Childhood Mental Disorders","code_information":[{"code":"431","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning & toxic Effects of Drugs Age >17 w CC","code_information":[{"code":"449","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications of treatment w CC","code_information":[{"code":"452","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Mcc","code_information":[{"code":"453","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Cc","code_information":[{"code":"454","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","code_information":[{"code":"455","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"459","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","code_information":[{"code":"484","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","code_information":[{"code":"490","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w/o CC/MCC","code_information":[{"code":"491","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","code_information":[{"code":"523","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient ischemia","code_information":[{"code":"524","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other heart assist system implant","code_information":[{"code":"525","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"526","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"527","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Proc w Pdx Hemorrhage","code_information":[{"code":"528","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular shunt procedures w CC","code_information":[{"code":"529","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures w/o CC","code_information":[{"code":"530","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w CC","code_information":[{"code":"531","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w/o CC","code_information":[{"code":"532","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","code_information":[{"code":"567","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","code_information":[{"code":"568","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small & Large Bowel Procedures w CC w Major Gi Dx","code_information":[{"code":"569","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Admit For Renal Dialysis","code_information":[{"code":"685","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W Cc/Mcc","code_information":[{"code":"691","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","code_information":[{"code":"692","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W Cc/Mcc","code_information":[{"code":"765","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W/O Cc/Mcc","code_information":[{"code":"766","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Sterilization &/Or D&C","code_information":[{"code":"767","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Complicating Diagnoses","code_information":[{"code":"774","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W/O Complicating Diagnoses","code_information":[{"code":"775","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ectopic Pregnancy","code_information":[{"code":"777","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Threatened Abortion","code_information":[{"code":"778","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"False Labor","code_information":[{"code":"780","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W Medical Complications","code_information":[{"code":"781","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W/O Medical Complications","code_information":[{"code":"782","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","code_information":[{"code":"984","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","code_information":[{"code":"985","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","code_information":[{"code":"986","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Principal Diagnosis Invalid As Discharge Diagnosis","code_information":[{"code":"998","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [All Other IP (%BC): 30]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":308.96,"10th_percentile":308.96,"90th_percentile":308.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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] [All Other IP (%BC): 18.93]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 9.34 | Excess % of Charge: 28.6] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 8.47 | Excess % of Charge: 28.60] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3819] [Normal Vaginal Delivery-Per Diem: 3300]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 7763] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 7694] [Normal Vaginal Delivery-Case Rate: 5077] [Nursery  Level 1- Boarder-Per Diem: 1264] [Nursery  Level 2-Per Diem: 2283] [Nursery  Level 3-Per Diem: 2283] [Nursery  Level 4-NICU-Per Diem: 2283] [Rehab-Per Diem: 2239] [SNF-Per Diem: 1034] [Hospice-Per Diem: 701]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 6937] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 6874] [Normal Vaginal Delivery-Case Rate: 4534] [Nursery  Level 1- Boarder-Per Diem: 1130] [Nursery  Level 2-Per Diem: 2040] [Nursery  Level 3-Per Diem: 2040] [Nursery  Level 4-NICU-Per Diem: 2040] [Rehab-Per Diem: 2001] [SNF-Per Diem: 924] [Hospice-Per Diem: 627]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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15","code_information":[{"code":"G0540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.25,"maximum":31.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31.88,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28.22,"additional_payer_notes":"APC"}]}]},{"description":"Safety plan interven","code_information":[{"code":"G0560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.54,"maximum":59.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care 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the standard charge value."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care 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presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Pregnant/parenting women's program","code":"HD","modifier_payer_information":[{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Distinct Procedural Service","code":"59","modifier_payer_information":[{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Reduced Services","code":"52","modifier_payer_information":[{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional","code":"76","modifier_payer_information":[{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Investigational clinical service provided in a clinical research study that is in an approved clinical research study","code":"Q0","modifier_payer_information":[{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Left side (used to identify procedures performed on the left side of the body)","code":"LT","modifier_payer_information":[{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Right side (used to identify procedures performed on the right side of the body)","code":"RT","modifier_payer_information":[{"payer_name":"Bcbs","plan_name":"Hpn Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Ppo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Core/Navigate Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Hmo","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Bcbs","plan_name":"Choice Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Longevity","plan_name":"I-Snp Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Mmai Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clear Spring Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Longevity","plan_name":"I-SNP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]}],"additional_information":[{"financial_aid_policy":[{"Policy Line":"80010031","HB OBSERVATION - TELEMETRY SITTER":"HB OBSERVATION - STANDARD ROOM SITTER","762":762,"G0378":"G0378","1809":953,"141":56,"1868":984,"146":58},{"Policy Line":"80010032","HB OBSERVATION - TELEMETRY SITTER":"HB OBSERVATION - STANDARD ROOM","762":762,"G0378":"G0378","1809":953,"141":56,"1868":984,"146":58},{"Policy Line":"80010040","HB OBSERVATION - TELEMETRY SITTER":"HB OUTPT IN A BED (OPIB) - 1ST HOUR","762":762,"1809":953,"141":56,"1868":984,"146":58},{"Policy Line":"80010042","HB OBSERVATION - TELEMETRY SITTER":"HB OBSERVATION TELEMETRY ISOLATION","762":762,"G0378":"G0378","1809":1850,"141":146,"1868":1910,"146":151},{"Policy Line":"80010043","HB OBSERVATION - TELEMETRY SITTER":"HB OBSERVATION OBSTETRICS LEVEL 2","762":762,"G0378":"G0378","1809":1143,"141":105,"1868":1180,"146":108}]}]}